• Tuberculosis and Respiratory Diseases
• /
• 제87권1호
• /
• pp.40-51
• /
• 2024

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia with a very poor prognosis. Accurate diagnosis of IPF is essential for good outcomes but remains a major medical challenge due to variability in clinical presentation and the shortcomings of existing diagnostic tests. Medical history collection is the first and most important step in the IPF diagnosis process; the clinical probability of IPF is high if the suspected patient is 60 years or older, male, and has a history of cigarette smoking. Systemic assessment for connective tissue disease is essential in the initial evaluation of patients with suspected IPF to identify potential causes of interstitial lung disease (ILD). Radiologic examination using high-resolution computed tomography plays a pivotal role in the evaluation of patients with ILD, and prone and expiratory computed tomography images can be considered. If additional tests such as surgical lung biopsy or transbronchial lung cryobiopsy are needed, transbronchial lung cryobiopsy should be considered as an alternative to surgical lung biopsy in medical centers with experience performing this procedure. Diagnosis through multidisciplinary discussion (MDD) is strongly recommended as MDD has become the cornerstone for diagnosis of IPF, and the scope of MDD has expanded to monitoring of disease progression and suggestion of appropriate treatment options.

• Tuberculosis and Respiratory Diseases
• /
• 제48권3호
• /
• pp.315-323
• /
• 2000

연구배경 : 현행 도말 및 배양등의 미생물학적 검사법의 제한점을 보완 또는 보조할 수 있는 신속한 결핵진단 방법의 하나로서 가장 많이 연구 되어온 분야가 혈청학적인 방법이다. 이 중 현재까지 결핵의 혈청학적 진단에 유용성이 높은 것으로 평가되는 항원의 하나가 38KDa으로 대표되는 결핵균 분비항원이다. 마침, 이 38KDa 항원을 주항원 성분으로 하여, 간편하게 실험할 수 있도록 kit화된 제품이 국내외에서 널리 시판되고 있기에(ICT-TB, 호주 ICT Diagnostics사) 이를 이용, 결핵의 혈청학적 진단이 얼마나 유용할 것인지를 평가하고자 하였다. 방 법 : 결핵이 없는 7세 이하 아동 21명과 건강 성인 47명 등 총 68명의 대조군과, 치료 개시 전에는 균양성이었으나 ICT 검사 당시는 균이 나오지는 않았던 치료 중인 폐결핵환자 82명 (결핵성 흉막염 환자 3명 포함) 및 균양성으로 당시 치료 중이던 폐결핵환자 40명 등, 총 122명의 결핵환자를 대상으로 하여 결핵의 혈청학적 진단용 kit인 ICT를 이용하여 시험하였다. 결 과 : 1. 결핵환자가 아닌 대조용 대상자 68명(7세 이하 아동 21명 포함)에 대한 ICT의 양성반응률 (위양성률)은 13.2%였고, 음성반응률 (결핵환자가 아닌 것으로 판정되는 율, true negative)은 86.8%였다. 2. 시험된 대상 결핵환자 122명에 대한 ICT에 의한 양성반응률은 86.9%, 음성반응률은 13.1%였다. 3. 균양성 폐결핵 환자 40명에 대한 ICT 양성률은 95.0% (38명), 음성률은 5.0% (2명)였다. 4. 폐외결핵환자 3명을 포함한, 현재 치료 중에 있는 균음성 결핵환자에 82명에 대한 ICT의 양성반응률은 82.9%(68 명), 음성반응률은 17.1%(14명)였다. 그러나, 균양성 결핵환자와 균음성인 결핵환자간 ICT 양성률에는 통계적으로 유의한 차이가 없었다(P>0.05). 5.ICT의 민강도와 특이도는 모두 87%였으며, 위양성률과 위음성률도 같은 13%였다. 또 유병율이 64% 수준일 때의 양성예측률은 92.2%, 음성예측률은 78.7%였다. 결 론 : ICT의 높은 위양성률과 진단능률(diagnosability) 등을 고려할 때, 결핵이 의심되지만 기존의 도말 및 배양검사 결과를 얻기 어려운 대상자에게만 필요에 따라 제한적으로 활용해볼 수 있는 검사인 것으로 판단되었다.

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

• Tuberculosis and Respiratory Diseases
• /
• 제44권2호
• /
• pp.223-231
• /
• 1997

A total of 322 patients with endobronchial tuberculosis (8.1%) out of 3,982 subjects who had a flexible fiberoptic bronchoscopic examination at the Department of Pulmonary Medicine of Hanyang University Hospital between the beginning of March 1982 and the end of April 1996 were included in this study. The peak incidence occurred in the second decade, and the male to female was 1 : 3.0. The barking cough with variable amounts of sputum was the most common chief complaint in 56.9% of the 313 patients. Other complaints included dyspnea, chest pain, fever, hemoptysis, and generalized weakness. Localized wheeze was heard over the chest in 16.9% of the 313 patients. Infiltration/consolidation was the most common roentgenographic finding of the chest in 64.2%. Bronchoscopically, hypertrophy with luminal narrowing was the most common findings in 32.3% of the 322 patients and left main bronchus was the most frequently involved in 24.0%. Using fiberoptic bronchoscopy allows not only substantial meaningful assessment of endobronchial tuberculosis but also makes a differential diagnosis of lung cancer in older patients. We need further evaluations of standard bronchoscopic classification of endobronchial tuberculosis, diagnostic accuracy of endobronchial tuberculosis by PCR, a large prospective study of effects of corticosteroids in endobronchial tuberculosis patients, and appropriate treatment of atelectasis by endobronchial tuberculosis.

• 대한두개안면성형외과학회지
• /
• 제20권4호
• /
• pp.274-278
• /
• 2019

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule ($1.5{\times}1.2cm$) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.

• Pediatric Infection and Vaccine
• /
• 제5권1호
• /
• pp.69-78
• /
• 1998

목 적 : 1세 미만 영아들은 결핵에 이환될 경우 뇌막염이나 속립성 결핵 등의 심한 질환으로 진행할 위험이 다른 연령군에 비하여 높으므로 이들에서 결핵의 조기 진단에 의한 신속한 치료가 매우 중요하다. 본 연구는 1세 미만 영아 결핵 환아들의 임상적인 특징을 관찰하여 향후 진단, 치료 및 예방에 도움을 얻고자 하였다. 방 법 : 1985년 7월부터 1997년 4월까지 서울대학교 어린이병원 소아과에 입원했던 1세 미만의 결핵 환아 29명의 의무 기록을 검토하여 후향적으로 분석하였다. 결핵의 진단은 각종 가검물에서 M. tuberculosis가 분리되거나(13례) 병리학적으로 결핵과 부합하는 소견을 보이는 경우(1례)를 포함하였으며, 미생물학적 병리학적 증거를 얻지 못한 예들에서는 성인결핵 환자에의 노출력, 임상 양상, 흉부 방사선 소견, 5 투베르쿨린 단위로 시행한 망토우 반응 결과 및 치료에 대한 반응 등을 종합하여 개별적으로 판단하였다. 결 과 : 질환의 형태는 단독 폐결핵으로 나타난 경우가 12례로 가장 많았고, 뇌막염이 동반된 폐결핵 5례, 폐결핵과 림프절염 3례, 뇌막염 3례 및 속립 결핵 6례 등이었다. 환아들의 평균 나이는 7개월이었다. 감염원을 찾을 수 있었던 경우가 19례였으며, 이 중 환아에서 결핵이 의심되어 주변 어른을 검사한 결과 결핵이 발견된 경우가 7례였다. 처음 방문시 증상이 있었던 경우가 27례였으며 주소는 호흡기 증상이 12례, 중추신경계 증상이 10례였다. 호흡기 증상은 기침, 가래 외에도 빈호흡, 천명 등의 호흡 곤란 증상이 7례에서 있었다. 폐 청진상 수포음이 6례, 천명이 7례, 호흡음의 감소가 9례에서 있었고, 간비종대가 흔하였다. 흉부 방사선 검사상 이상이 26례에서 있었고 이 중 폐문부 림프절을 동반한 폐실질의 병변을 보였던 경우가 18례로 가장 많았다. 국소적 또는 전반적인 기종성 변화가 7례에서 있었다. 결 론 : 영아들은 결핵 진단시 증상을 갖고 있는 경우가 대부분이었고, 폐결핵의 발병시 천명, 기종성 변화, 호흡음 감소 등의 기관지 폐쇄의 징후가 흔하며 호흡 부전으로 진행할 수 있으므로 진단 및 치료에 주의를 요한다. 성인 결핵 환자 발생시 노출된 영아에 대한 예방 요법을 철저히 시행하여야 하며, 영아에서 결핵이 의심될 때 감염원을 찾음으로써 진단에 도움을 줄 수 있다는 사실을 재확인하였다.

• Tuberculosis and Respiratory Diseases
• /
• 제81권1호
• /
• pp.59-72
• /
• 2018

Background: It remains uncertain if $interferon-{\gamma}$ release assays (IGRAs) are superior to the tuberculin skin test (TST) for the diagnosis of active tuberculosis (TB) or latent tuberculosis infection (LTBI) in immunosuppressed populations including people with human immunodeficiency virus (HIV) infection. The purpose of this study was to systematically review the performance of IGRAs and the TST in people with HIV with active TB or LTBI in low and high prevalence TB countries. Methods: We searched the MEDLINE database from 1966 through to January 2017 for studies that compared results of the TST with either the commercial QuantiFERON-TB Gold in Tube (QFTGT) assay or previous assay versions, the T-SPOT.TB assay or in-house IGRAs. Data were summarized by TB prevalence. Tests for concordance and differences in proportions were undertaken as appropriate. The variation in study methodology was appraised. Results: Thirty-two studies including 4,856 HIV subjects met the search criteria. Fourteen studies compared the tests in subjects with LTBI in low TB prevalence settings. The QFTGT had a similar rate of reactivity to the TST, although the first-generation version of that assay was reactive more commonly. IGRAs were more frequently positive than the TST in HIV infected subjects with active TB. There was considerable study methodology and population heterogeneity, and generally low concordance between tests. Both the TST and IGRAs were affected by CD4 T-cell immunodeficiency. Conclusion: Our review of comparative data does not provide robust evidence to support the assertion that the IGRAs are superior to the TST when used in HIV infected subjects to diagnose either active TB or LTBI.

• 대한의생명과학회지
• /
• 제22권1호
• /
• pp.24-28
• /
• 2016

Tuberculosis (TB) remains an unsolved community health problem since identification of its causing microorganism called Mycobacterium tuberculosis (MTB) by Robert Koch in 1882. Annually, eight million TB cases are newly reported and 2~3 million patients die from TB. Pulmonary TB is highly infectious and untreated pulmonary TB patients are believed to infect >10 people in a year. The conventional methods for diagnosis of TB are chest X-ray and isolation of the causing microorganisms from patient specimens. Screening of TB is conducted with smeared sputum in slides, and TB is confirmed by identification of MTB in cultured specimens. One of the fatal pitfalls of screening detection for smeared sputum is that it is impossible to distinguish MTB and other acid-fast bacilli (AFB) because they are stained equally with Ziehl-Neelsen (ZN) stain. Culture of MTB is the most reliable method for diagnosis of TB but it takes 4~8 weeks. In this report, we suggest a fast and highly-reliable MTB detection method that distinguishes AFB in sputum samples. Purified DNA from the AFB stained slide samples offered by The Korean Institute of Tuberculosis were used to detect infected MTB in patients. PCR, real-time PCR and reverse blot hybridization assay (REBA) methods were applied to purified DNA. Conclusively, the real-time PCR method was confirmed to produce high sensitivity and we were able to further detect drug-resistant MTB with REBA.

• 대한세포병리학회지
• /
• 제10권1호
• /
• pp.35-42
• /
• 1999

The accuracy of fine needle aspiration cytology(FNAC) of the lymph node was investigated through a review of 176 FNAC cases and the corresponding biopsies. We chose 157 FNAC cases after the exclusion of 19 inadequate ones. Sensitivity of malignancy was 94.0%, specificity 100%, false negativity 6.0%, and false positivity 0.0%. The overall diagnostic accuracy was 96.8%. Sensitivity of metastatic carcinoma was 98.0% and that of malignant lymphoma was 87.9%. False negative cases included one metastatic carcinoma and four malignant lymphomas. The aspirates of metastatic carcinoma with false negativity exhibited a diffuse smear of keratin debris without viable cells, which led to the difficulty in differentiation from benign epithelial cyst. The cases of malignant lymphoma with false negative diagnosis were two Hodgkin diseases, one Lennert's lymphoma, and one peripheral T cell lymphoma in the histologic sections. On the analysis of 39 cases of tuberculosis, 17 cases(43.6%) were diagnosed as tuberculosis, 4(10.3%) as granulomatous lymphadenitis, 3(7.7%) as necrotizing lymphadenitis, and 15(38.5%) as reactive hyperplasia or pyogenic inflammation. Sensitivity of tuberculosis was 53.9%. In conclusion, lymph node FNAC is an excellent non-invasive diagnostic tool for the diagnosis of metastatic carcinoma. The diagnostic accuracy of malignant lymphoma could be improved with flow cytometry or polymerase chain reaction for antigen receptor genes. For the FNAC diagnosis of tuberculosis, AFB stain, culture, and PCR would be helpful as adjuvant techniques.

• Tuberculosis and Respiratory Diseases
• /
• 제42권4호
• /
• pp.584-587
• /
• 1995

저자들은 좌측유방에 분비물이 동반된 무동의 종물을 주소로 내원한 젊은여성에서 일반적인 항생제투여 및 배농등의 치료에 반응하지 않아 실시한 세침흡인 및 생검상 만성 염증성 육아종성변화로 나타나 유방결핵으로 진단된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.