• Tuberculosis and Respiratory Diseases
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• v.87 no.3
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• pp.302-308
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• 2024

In cases where pulmonary tuberculosis (PTB) is not microbiologically diagnosed via sputum specimens, bronchoscopy has been the conventional method to enhance diagnostic rates. Although the additional benefit of bronchoscopy in diagnosing PTB is well-known, its overall effectiveness remains suboptimal. This review introduces several strategies for improving PTB diagnosis via bronchoscopy. First, it discusses how bronchoalveolar lavage or an increased number of bronchial washings can increase specimen abundance. Second, it explores how thin or ultrathin bronchoscopes can achieve specimen acquisition closer to tuberculosis (TB) lesions. Third, it highlights the importance of conducting more sensitive TB-polymerase chain reaction tests on bronchoscopic specimens, including the Xpert MTB/RIF assay and the Xpert MTB/RIF Ultra assay. Finally, it surveys the implementation of endobronchial ultrasound with a guide sheath for tuberculomas, collection of post-bronchoscopy sputum, and reduced use of lidocaine for local anesthesia. A strategic combination of these approaches may enhance the diagnostic rates in PTB patients undergoing bronchoscopy.

• Tuberculosis and Respiratory Diseases
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• v.80 no.1
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• pp.27-34
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• 2017

Background: A sputum culture is the most reliable indicator of the infectiousness of pulmonary tuberculosis (PTB); however, a spontaneous sputum specimen may not be suitable. The aim of this study was to evaluate the infectious period in patients with non-drug-resistant (DR) PTB receiving adequate standard chemotherapy, using induced sputum (IS) specimens. Methods: We evaluated the duration of infectiousness of PTB using a retrospective cohort design. Results: Among the 35 patients with PTB, 22 were smear-positive. The rates of IS culture positivity from baseline to the sixth week of anti-tuberculosis medication in the smear-positive PTB group were 100%, 100%, 91%, 73%, 36%, and 18%, respectively. For smear-positive PTB cases, the median time of conversion to culture negativity was 35.0 days (range, 28.0-42.0 days). In the smear-negative PTB group (n=13), the weekly rates of positive IS culture were 100%, 77%, 39%, 8%, 0%, and 0%, respectively, and the median time to conversion to culture-negative was 21.0 days (range, 17.5-28.0 days). Conclusion: The infectiousness of PTB, under adequate therapy, may persist longer than previously reported, even in patients with non-DR PTB.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.33 no.2
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• pp.134-144
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• 2023

Objectives: Active pulmonary tuberculosis (active PTB) is manifested in one of the complications of pneumoconiosis, but statistics are not available. The objective of the present study was to identify the incidence of active PTB among dusty workers who were diagnosed with pneumoconiosis by year. Methods: The present study was performed using the results of the Pneumoconiosis Examination Council's assessment from the Korea Workers' Compensation and Welfare Service (KCOMWEL) database between January 1, 1984, and December 31, 2017. Pneumoconiosis is defined as Category 1 or more. Active PTB was defined as a positive result for active PTB in the result of the Pneumoconiosis Examination Council's assessment. The annual incidence rate of pneumoconiosis and active PTB were analyzed by age standardization. Results: The number of retired dusty workers who received the health examination for work-related pneumoconiosis increased every year. However, the incidence of pneumoconiosis among retired dusty workers and active PTB among patients with pneumoconiosis decreased every year. Conclusions: To effectively manage pneumoconiosis and active PTB among patients with pneumoconiosis, the annual status of them in retired dusty workers who received the health examination for work-related pneumoconiosis was required.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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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.

• Journal of Korean Academy of Nursing
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• v.47 no.1
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• pp.60-70
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• 2017

Purpose: This study was conducted to construct and test a structural equation model of health-related quality of life (HRQoL) among hospitalized patients with pulmonary tuberculosis (PTB). Methods: Participants were 256 patients with PTB who were 20 years or older and admitted in two national tuberculosis hospitals. The patients participated in pulmonary function testing and responded to structured questionaries. Results: The goodness-of-fit statistics of the final hypothetical model were as follows: ${\chi}^2/df=2.19$, RMSEA=.07, SRMR=.05, GFI=.95, NFI=.95, CFI=.96, TLI=.92, and PCFI=.52. Symptoms and general health perception had significant direct effects, and subjective economic status, social support and stigma had significant indirect effect on HRQoL of hospitalized patients with PTB. These variables explained 64% of variance in the prediction model. Conclusion: Findings suggest that strategies and intervention for physical symptoms and depressive symptoms are crucial to improve the quality of life in hospitalized patients with PTB. The development of various social support programs is also recommended.

• Tuberculosis and Respiratory Diseases
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• v.73 no.1
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• pp.38-47
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• 2012

Background: The prevalence rate of pulmonary tuberculosis (PTB) is steadily decreasing in South Korea. However, PTB is a disease with relatively high mortality and morbidity rates throughout Korea. Although there are many studies and statistics about the risk factors of PTB mortality in many countries, there are only a limited number of domestic papers on this topic. The aim of this study is to determine predictive factors for mortality among in-hospital patients associated with PTB. Methods: From December 2006 to January 2011, we reviewed medical records of 2,122 adult patients diagnosed with tuberculosis at a single tertiary hospital in a suburban area. In this study period, 960 patients were diagnosed with PTB by positive Acid fast bacilli smear and/or mycobacterial culture of the respiratory specimen. We compared the groups of patients deceased and patients discharged alive with PTB. The number of dead patients was 82 (47 males, 35 females). Results: Mortality was significantly associated with increased values of white blood cells (WBC), blood urine nitrogen (BUN), creatinine, C-reactive protein (CRP), numbers of involved lung field, and length of hospitalization. Also, it was associated with the decreased values of hemoglobin, lymphocyte, sodium, albumin, and cholesterol. Furthermore, admission through the emergency department, initial intensive care unit admission, and drug resistant PTB affected mortality in PTB patients. Independent predictors associated with PTB mortality are BUN, initial intensive care unit care, and admission during treatment of tuberculosis. Conclusion: In our study, mortality of pulmonary tuberculosis was related with parameters associated with nutritional status, disease severity at the time of admission, and drug resistance.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.232-238
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• 2015

Background: A relationship between low vitamin D levels and the development or outcomes of respiratory diseases has been identified. However, there is no data on the vitamin D status in patients with acute eosinophilic pneumonia (AEP). We evaluated the vitamin D status in patients with AEP among South Korean military personnel. Methods: We prospectively compared the serum levels of total 25-hydroxyvitamin D [25(OH)D], 25(OH)D3, and 25(OH)D2 among patients with AEP, pulmonary tuberculosis (PTB), and community-acquired pneumonia (CAP). Results: In total, 65 patients with respiratory diseases, including AEP (n=24), PTB (n=19), and CAP (n=22), were identified. Of the 24 patients with AEP, 2 (8%) had deficient total 25(OH)D levels (<10 ng/mL), 17 (71%) had insufficient total 25(OH)D levels (${\geq}10$ to <30 ng/mL), and only 5 (21%) had sufficient total 25(OH)D levels (${\geq}30$ to <100 ng/mL). The difference in the total 25(OH)D levels among patients with AEP, PTB, and CAP was not statistically significant (p=0.230). The median levels of total 25(OH)D, 25(OH)D3, and 25(OH)D2 were 22.84, 22.84, and 0.00 ng/mL, respectively, and no differences in the 25(OH)D level were present among patients with AEP, PTB, and CAP with the exception of the total 25(OH)D level between patients with AEP and PTB (p=0.042). Conclusion: We have shown that low vitamin D levels are frequently found in patients with AEP and are comparable with those in patients with PTB and CAP.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.29 no.4
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• pp.582-589
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• 2019

Objectives: Although active pulmonary tuberculosis(active PTB) is manifested as one of the complications of pneumoconiosis, attacks of active PTB among patients with pneumoconiosis is still unexplored. The objective of the present study was to identify the attack rate of active PTB among workers in dusty environments who were diagnosed with pneumoconiosis. Methods: The study was performed using the results of the Pneumoconiosis Examination Council's assessment from the Korea Workers' Compensation and Welfare Service(KCOMWEL) database between January 1, 1984 and December 31, 2017. Pneumoconiosis was defined as Category 1 or more in the radiological findings of pneumoconiosis. Active PTB was defined as a positive result for active PTB in the results of the Pneumoconiosis Examination Council's assessment. Results: A total of 37,946 workers in dusty environments who received a health examination for diagnosing pneumoconiosis between January 1, 1984 and December 31, 2017 were selected as study subjects. The attack rate of active TB among subjects who were diagnosed with pneumoconiosis and those who were diagnosed without pneumoconiosis were 8.5% and 1.4%, respectively. In the multivariate logistic analysis including age, sex, radiological findings, complications, male[odds ratio(OR), 2.0; 95% confidence interval(CI), 1.4-3.1] and pneumoconiosis(OR, 6.5; 95% CI, 5.7-7.4) were associated with an increased risk of developing active PTB. Conclusions: The present study determined that dusty workers who were diagnosed with pneumoconiosis had a high rate of active PTB compared to TB patients and patients who were diagnosed with silicosis. Therefore, in addition to silicosis, it is necessary to include pneumoconiosis among the high-risk groups for TB.

• Journal of Chest Surgery
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• v.50 no.1
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• pp.50-53
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• 2017

A mixed infection of Mycobacterium abscessus subsp. abscessus (Mab) and Mycobacterium tuberculosis (MTB) in the lung is an unusual clinical manifestation and has not yet been reported. A 61-year-old woman had been treated for Mab lung disease and concomitant pneumonia, and was diagnosed with pulmonary tuberculosis (PTB). Despite both anti-PTB and anti-Mab therapy, her entire left lung was destroyed and collapsed. She underwent left pneumonectomy and received medical therapy. We were able to successfully treat her mixed infection by pneumonectomy followed by inhaled amikacin therapy. To the best of our knowledge, thus far, this is the first description of a mixed Mab and MTB lung infection.

• Journal of Biomedical Engineering Research
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• v.38 no.1
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• pp.25-31
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• 2017

Testing TB in chest X-ray images is a typical method to diagnose presence and magnitude of PTB lesion. However, the method has limitation due to inter-reader variability. Therefore, it is essential to overcome this drawback with automatic interpretation. In this study, we propose a novel method for detection of PTB using SegNet, which is a deep learning architecture for semantic pixel wise image labelling. SegNet is composed of a stack of encoders followed by a corresponding decoder stack which feeds into a soft-max classification layer. We modified parameters of SegNet to change the number of classes from 12 to 2 (TB or none-TB) and applied the architecture to automatically interpret chest radiographs. 552 chest X-ray images, provided by The Korean Institute of Tuberculosis, used for training and test and we constructed a receiver operating characteristic (ROC) curve. As a consequence, the area under the curve (AUC) was 90.4% (95% CI:[85.1, 95.7]) with a classification accuracy of 84.3%. A sensitivity was 85.7% and specificity was 82.8% on 431 training images (TB 172, none-TB 259) and 121 test images (TB 63, none-TB 58). This results show that detecting PTB using SegNet is comparable to other PTB detection methods.