• Tuberculosis and Respiratory Diseases
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• 제79권3호
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• pp.134-142
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• 2016

In recent years, in spite of medical advancement, tuberculosis (TB) remains a worldwide health problem. Although many laboratory methods have been developed to expedite the diagnosis of TB, delays in diagnosis remain a major problem in the clinical practice. Because of the slow growth rate of the causative agent Mycobacterium tuberculosis, isolation, identification, and drug susceptibility testing of this organism and other clinically important mycobacteria can take several weeks or longer. During the past several years, many methods have been developed for direct detection, species identification, and drug susceptibility testing of TB. A good understanding of the effectiveness and practical limitations of these methods is important to improve diagnosis. This review summarizes the currently-used advances in non-molecular and molecular diagnostics.

• Pediatric Infection and Vaccine
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• 제18권1호
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• pp.1-14
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• 2011

Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite the decrease in the incidence of tuberculosis in Korea, more than 30,000 new patients are diagnosed each year. Active tuberculosis is less frequent in children compared to adults but the risk of miliary tuberculosis and CNS tuberculosis is much higher. The diagnosis of tuberculosis in children and adolescents is difficult due to the nonspecific symptoms upon presentation. Diagnostic work up is based on the confirmation of tuberculosis infection by tuberculin skin test, abnormal radiologic findings, and contact with an adult with active tuberculosis. Anti-tuberculosis medications are prescribed according to the drug susceptibility of the index patient. Latent tuberculosis infection plays an important role in adult tuberculosis by reactivation. Thus, it is critical to accurately diagnose latent tuberculosis in children to prevent reactivation in adulthood. Korean guidelines for diagnosis and treatment of tuberculosis in children and adolescents provide evidence based recommendations in the optimal diagnosis and treatment for active and latent tuberculosis in children and adolescents based on the current Korean situation.

• Tuberculosis and Respiratory Diseases
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• 제78권2호
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• pp.56-63
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• 2015

A small number of viable tuberculosis bacilli can reside in an individual with latent tuberculosis infection (LTBI) without obvious clinical symptoms or abnormal chest radiographs. Diagnosis and treatment for LTBI are important for tuberculosis (TB) control in public and private health, especially in high-risk populations. The updated 2014 Korean guidelines for TB recommend that tuberculin skin tests, interferon-gamma release assays, or a combination of the two can be used for LTBI diagnosis according to age and immune status of the host as well as TB contact history. The regimens for LTBI treatment include isoniazid, rifampicin, or isoniazid/rifampicin. However, results of drug susceptibility test from the index case must be considered in selecting the appropriate drug for recent contacts. Standardized LTBI diagnosis and treatment based on the new 2014 guidelines will contribute to the effective TB control in Korea as well as to the establishment of updated guidelines.

• Tuberculosis and Respiratory Diseases
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• 제39권1호
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• pp.1-6
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• 1992

The diagnosis of tuberculosis is usually established using staining and culturing techniques. Fluorescent stains have improved the sensitivity of direct microscopy. Improved culture media coupled with radiometric means of detecting early mycobacterial growth have shortened the time needed for cultural diagnosis. Rapid immunodiagnostic techniques based on the detection of mycobacterial antigen or of antibodies to theses antigens have not, however, come into widespread clinical use. The DNA or RNA hybridization tests with labeled specific probes which have been described so far are not sensitive enough to be used for clinical speicimens without prior culturing. The advent of the polymerase chain reaction (PCR) has opened new possibilities for diagnosis of microbial infections. This technique has already been applied to a number of microorganisms. In the field of mycobacteria the PCR has been used to identify and to detect DNAs extracted from various mycobacteria. However, despite the extraordinary enthusiasm surrounding this technique and the considerable investiment, PCR has not emerged from the developmental "trenches" in the passed several years. It may be a considerable lenth of time before clinical microbiology laboratories become PCR playgrounds because many details remain to be worked out.

• Tuberculosis and Respiratory Diseases
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• 제77권1호
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• pp.1-5
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• 2014

The recovery of nontuberculous mycobacteria (NTM) from respiratory specimens and the number of patients with NTM lung disease have been rapidly increasing in Korea. An early differential diagnosis of NTM lung disease from pulmonary tuberculosis (TB) is important, as the therapeutic regimen differs from that of pulmonary TB, and it is not necessary to track the contacts of patients with NTM lung disease. However, differentiating NTM lung disease from pulmonary TB remains difficult, because the clinical presentations of the two diseases are similar and a definite diagnosis of NTM lung disease based on sputum culture takes time. This review focuses on the changing epidemiology, clinical and radiographic manifestation, and laboratory diagnosis of pulmonary TB and NTM lung disease in Korea.

• Tuberculosis and Respiratory Diseases
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• 제47권3호
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• pp.311-320
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• 1999

연구 배경 : 최근 전세계적으로 결핵이 증가하며 새로운 문제로 대두되고 있으며, 특히 결핵의 유병률이 높은 우리나라의 경우에는 민감도가 높으며 간편한 검사방법 이 필요하다. M. tuberculosis 항원을 사용한 rapid membrane based assay 검사 방법으로 최근에 폐결핵 환자의 결핵항원 특이 항체를 검출한다고 알려진 상용화된 2 가지 kit를 이용하여 폐결핵의 혈청학적 진단 가능성을 알아보고자 하였다. 방법 : 1998년 3월부터 9월까지 충남대학교 병원에서 입원 치료를 받은 호흡기 환자 총 45예를 대상으로 하였다. 객담 도말 양성의 활동성 폐결핵 22예와 비활동성 폐결핵 14예 그리고 대조군으로 비결핵성 호흡기 질환 9예를 대상으로 하여 STAT-PAK ULTRA FAST$^{(R)}$ 및 ICT tuberculosis$^{(R)}$ 검사를 실시하여 결핵 혈청 검사의 유용성을 알아보고 자하였다. 결과: STAT-PAK ULTRA FAST$^{(R)}$의 경우에는 폐결핵과 비활동성 폐결핵의 비교에서 민감도는 77.3%, 28.6%, 양성 63.0%, 음성 예측도는 44.4%, 위양성률은 71.4%, 위음성률은 22.7% 이었고, 활동성 폐결핵과 비결핵성 호흡기 질환의 비교에서는 민감도는 77.3%, 특이도는 33.3%, 양성 예측도는 73.9%, 음성 에측도는 37.5%, 위양성률은 66.7%, 위음성률은 22.7% 이었다. ICT tuberculosis$^{(R)}$의 경우에는 활동성 폐결핵과 비활동성 폐결핵의 비교에서는 민감도는 54.5%. 특이도는 57%, 양성 예측도는 66.7%, 음성 예측도는 44.4%, 위양성률은 42.9%, 위음성률은 45.4 %이었고, 활동성 폐결핵과 비결핵성 호흡기 질환에서는 민감도는 54.5%, 특이도는 100%, 양성 예측도는 100%, 음성 예측도는 47.4%. 위양성률은 0%, 위음성률은 45.4%이었다. 폐결핵의 중증정도(extent) 와 양성율은 상기 2가지 kit에서 큰 차이가 없었다. 결론: 따라서 상기 2가지의 kit는 항체 반응이 다양하여 임상적으로 폐결핵의 진단에 이용하는 것에는 문제가 있다고 생각되며, 일단 양성반응을 보인 환자의 경우, 항결핵제 투여에 따른 추적 검사에서 항체가의 변화가 있는지에 대한 연구가 필요하리라 생각된다.

• Journal of Microbiology
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• 제40권4호
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• pp.301-304
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• 2002

Is a multiple number of sputum specimens necessary for the diagnosis of pulmonary tuberculosis? To answer this question, 6844 respiratory specimens obtained from previously untreated patients suspected of having pulmonary tuberculosis between 1998 and 2001 were evaluated retrospectively. All of the specimens were evaluated by acid fast bacilli smear and BACTEC 460 TB culture system. A total of 785 (11%) specimens from 353 patients were positive for Mycobacterium tuberculosis complex. For 76% (270/353) of these patients the organism was detected from sputum specimens collected sequentially for daily basis. Mycobacterium tuberculosis was isolated in the first, second and third samples of the majority (98%,195/199) of patients who had three or more sputum samples sent to the laboratory. Our results indicate that, we could carry out Mycobacterium tuberculosis isolation in the first, second and third sputum samples of the overwhelming majority of the patients and the diagnostic value of four or more sputum specimens submitted to the laboratory was very low (2%). We recommend that, for definitive and cost-effective diagnosis of pulmonary tuberculosis at least three sequential sputum specimens be collected for all patients suspected pulmonary tuberculosis.

• 대한두경부종양학회지
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• 제36권1호
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• pp.45-47
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• 2020

Tuberculosis of parotid gland is extremely rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or as primary involvement. Because of the clinical and radiological similarity, parotid tumor and parotid inflammatory disease take priority over the tuberculosis of parotid when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of tuberculosis of parotid gland in patient with a slowly growing parotid mass. However, its treatment is primarily medical if the positive diagnosis is well established. We have recently experienced a case of tuberculosis of parotid gland that was considered as the benign tumor preoperatively, but which was confirmed as tuberculosis of parotid gland after extracapsular dissection. We report it with a review of literature.

• The Korean Journal of Medicine
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• 제93권6호
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• pp.509-517
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• 2018

A small number of viable tuberculosis bacilli can reside in an individual with latent tuberculosis infection (LTBI) without obvious clinical symptoms or abnormal chest radiographs. Diagnosis and treatment of LTBI are important for tuberculosis (TB) control in public and private healthcare facilities, particularly in high-risk populations. The updated 2017 Korean guidelines for TB recommend that tuberculin skin tests, interferon-gamma release assays, or a combination of them can be used for the diagnosis of LTBI, depending on the age and immune status of the patient as well as their TB contact history. For diagnosis of LTBI, exclusion of active TB is essential, and the possibility of healed TB in those without a history of treatment for TB but at risk of its development must be considered. The treatment options for LTBI include isoniazid, rifampicin, isoniazid/rifampicin, and isoniazid/rifapentine. The benefits and risks of these agents based on the age of the patient and their hepatotoxicity must be considered when selecting the appropriate drug. Standardized diagnosis and treatment of LTBI based on the updated 2017 guidelines will contribute to the control of TB in Korea as well as to further revisions of the guidelines.

• Tuberculosis and Respiratory Diseases
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• 제78권3호
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• pp.203-209
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• 2015

Background: Induced sputum (IS) has been used to collect airway secretions in subjects who have inadequate sputum production. The aim of this study was to investigate the efficacy of IS for the diagnosis of pulmonary tuberculosis (PTB) in adults unable to expectorate sputum. Methods: Medical records of 39 PTB patients who underwent IS due to absence of spontaneous sputum production between January 2011 and March 2014 at a tertiary hospital in South Korea were reviewed. Results of acid fast bacilli smear, Mycobacterium tuberculosis culture and polymerase chain reaction assay for M. tuberculosis (TB-PCR) of IS specimens from these patients were analyzed. Clinical and high-resolution computed tomography (HRCT) characteristics were also analyzed to find characteristics associated with IS culture positivity. Results: Of the 39 IS specimens from PTB patients, 7 (17.9%) were smear positive and 31 (79.5%) were culture positive. Twenty-four IS specimens were tested for TB-PCR and 13 (54.2%) were positive on TB-PCR. Multivariate analysis showed that younger age (p=0.04) and presence of tree-in-bud appearance on HRCT (p=0.03) were independent predictors of IS culture positivity. Conclusion: IS is useful for the diagnosis of PTB in adults unable to expectorate sputum. Younger age and tree-in-bud appearance on HRCT were associated with IS culture positivity in these patients.