• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.485-494
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• 2004

Background : To assess the effects of mDOT implementation on sputum smear conversion for AFB (Acid fast bacilli) positive pulmonary tuberculosis patients, modified Directly Observed Treatment (mDOT) was started on October $8^{th}$ 2001 at a health center in Seoul. mDOT was defined through weekly interviewing and supervising of a patient by a supervisor (doctor, nurse, or lay health worker). The sputum smear conversion of a mDOT group was compared with that of a self-medication (self) group. Methods : This study included 52 AFB positive pulmonary tuberculosis patients registered at a health center in Seoul between October $8^{th}$ 2001 and April $23^{rd}$ 2002. 24 and 28 patients were enrolled in the mDOT and self medication groups, respectively. Paired (1:1) individual matching, by gender, extent of disease, relapse and age-matching variables, was performed between the two groups, resulting in 20 paired matches. This prospective study was planned as an unblinded, non-randomized quasiexperimental pilot project. Outcomes were identified from results of sputum smear examinations for AFB in both groups at 2 weeks, and 1 and 2 months. The paired matching data were analyzed using the SAS program version 8.1 by McNemar test. Results : At the end of 2 weeks of treatment, the sputum smear conversion of the mDOT group was somewhat higher than that of the self medication group (78.57 vs. 50%, p-value=0.289), and after 1 month of treatment no statistically significant difference was shown between the two groups (83.33 vs. 50, p-value=0.125). At the end of 2 months of treatment (initial intensive phase), the sputum smear conversions of the mDOT and self groups were 95 and 75%, respectively (p-value=0.219). Conclusions : The implementation of mDOT did not result in clinically significant increases in the sputum smear conversion at 2 weeks, and 1 and 2 months compared with that of the self medication group. However, the increases experienced might contribute to diminishing the infectious period of AFB positive patients, and this approach may act as a guide for a specific group of patients. In this study, mDOT was performed for one hundred percent of the intensive treatment phase. It can also be an effective treatment for pulmonary tuberculosis patients, and may be useful for some high risk tuberculosis patients.

• Tuberculosis and Respiratory Diseases
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• v.81 no.3
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• pp.233-240
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• 2018

Background: Non-conversion of sputum smear and culture prolongs the infectivity of the patient and has been associated with unfavorable outcomes. We aimed to evaluate factors associated with persistent sputum positivity at the end of two months of treatment of new case pulmonary tuberculosis (TB). Methods: Data of 87 human immunodeficiency virus-negative patients with culture-positive drug-susceptible pulmonary TB admitted to local university hospital between September 2015 and September 2016 were reviewed. Factors associated with sputum smear and/or culture positivity at the end of the second month of treatment were analyzed. Results: Twenty-two patients (25.3%) remained smear and/or culture-positive. Male sex, lower body mass index (BMI), unemployment, alcohol abuse, higher number of lobes involved and cavities on chest X-rays, shorter time to detection (TTD) on liquid cultures, higher respiratory sample smear grading and colony count in solid cultures, higher C-reactive protein, erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and anemia were all significantly associated with persistent sputum positivity. However, in the logistic regression analysis only male sex, lower BMI, alcohol abuse, higher radiological involvement, cavitation, higher smear grading, higher colony count in solid cultures and shorter TTD were determined as independent factors associated with persistent sputum positivity at the end of 2 months of treatment. Conclusion: In conclusion, higher sputum smear and culture grading at diagnosis, shorter TTD, higher number of lobes involved, cavitation, male sex, alcohol abuse, and lower BMI were independently associated with persistent sputum positivity. These factors should be sought when distinguishing which patients will remain infectious longer and possibly have worse outcomes.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.693-700
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• 1996

Background : Antituberculous therapy is set a short-term therpy used isoniazid(INH), rifampin(RFP), ethambutol(EMB), pyrazinamide(PZA) from 1970s' and treatment rate has been very improved. But drug interruption or irregular medication due to side effects and resistance of drug are serious problem to retreatment cases, specially. Ofloxasine(OFX), developed from Quinolone at 1980's is effective not only other respiratory infectious disease but also pulmonary tube rculosis. And this is useful drug instead of injection agents for retreatment patients who have side effects to other drugs, lived far distance from medical clinics. So, we will evaluate theffectiveness as four oral drugs involving OFX. Method : A retrospective study was made through the regular follow up of smear positive cases,who treated by four drug, namely, prothionamide (PTA) cycloserine(CS), OFX, paraminosalicylic acid(pAS). Results: 1) Out of 66case with positive sputum AFB smear, 42(64%)cases achieved the negative conversion. 2) Considering the negative conversion in all group, 34 case (52%) of sputum conversion occured within first 6 months, on the extent of diease was minimal, moderate, far advanced pulmonary tuberculosis, sputum AFB smear negative response to treatment was 100%, 78%, 46% respectively. 3) The roentgenological improvement occured in 38(58%), extent of diease was minimal, moderately, far advanced pulmonary tuberculosis, Roentgenological improvement to retreatment was 75%, 64%, 46%. 4) When the drnation of patients illness was less than 1 year, 1 to 3 years, 3 10 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 100%, 88%, 80%, 52 %. 5) On side effects, major problems are gastrointestinal troubles, mild liver function abnormality, psychotic problemes, and skin problem(urticaria, itching sensation). Conclusion : The duration & extents of patients illness was shorter & minimal, sputum AFB smear negative response rate was better. Radiologic response is better as shorter duration and minimal extent of diease. But, as diease is longer duration & far advanced, sputum negative conversion & Roentgenological improvement is poor and limited. The adverse reaction was mainly observed gastrointestinal troubles(indigestion, abdominal pain, nausea, vomiting, diarrhea) and are well controled by symptomatic management in most patients, as regard to tolerance to the secondary drugs.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.417-422
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• 2007

Background: It is not known with certainty whether patients with persistently positive sputum smear results who have also had negative sputum culture results require prolongation of treatment for tuberculosis in order to avoid an increased risk of eventual relapse. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the appropriate duration of treatment in these patients. Methods: Sixty of 69 patients with sputum smear positive and culture negative tests at 5 months after first line anti-tuberculous chemotherapy from 2002 to 2003 were retrospectively analyzed. Exclusion criteria included incomplete treatment or resistance to rifampicin or two additional antibiotics, as determined by a drug susceptibility test (DST). Results: Smear conversion of the study subjects was observed after $8.3{\pm}2.3$ months treatment, and the patients were culture negative after $2.0{\pm}0.8$ months. The relapse rates of the study subjects were 3.8, 10.0, and 25.8% after 1, 2, and 5 years of anti-tuberculosis chemotherapy, respectively. The relapse rates were not significantly affected by a series of risk factors such as age, sex, presence of diabetes, a sputum culture examination after 2 months treatment, previous treatment history, chest radiograph, and duration of the treatment (P>0.05). Conclusion: Regimen change is not required for patients with persistent smear positive but culture negative tests in the fifth month for first line antituberculous treatment. However, a further study will be needed to clarify the high relapse rate in this specific group of patients.

• Tuberculosis and Respiratory Diseases
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• v.42 no.3
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• pp.295-301
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• 1995

Background: The serious problems in retreatment of pulmonary tuberculosis are a significant proportion of drug resistance. Preferably retreatment should contain the drugs which has never used before, so drug retreatment is limited in selection. A new antibacterial substance, ofloxacin(OFX) is the activity against mycobacterium tuberculosis and it has been used in the treatment of pulmonary tuberculosis. The present report concerns the result of retreatment of pulmonary tuberculosis patients containing OFX treated at National Kongju Tuberculosis Hospital. Method: A retrospective study was made through the regular follow up of 92 smear positive cases, who were treated by four drugs regimen between Mar 1991 and June 1994 at National Kongju Tuberculosis Hospital. Four drugs were, namely prothionamide, cycloserine, ofloxacin and streptomycin(kanamycin or tuberactinomycin). The duration of follow up was over one year. Results: 1) Out of 92 cases with positive sputum AFB smear, 67(73%) achieved the negative conversion. 2) Considering the negative sputum conversion in all the groups, the vast majority(85%) of sputum conversion occurred within the first 4 months. 3) The roentgenological improvement occurred in 49 percent on the whole and when the extent of disease was minimal, moderately, far advanced pulmonary tuberculosis, sputum AFB smear negative response to retreatment was 100%, 93%, 68%, respectively. 4) When the duration of patient's illness was less than 1 year, 1 to 3 years, 3 to 5 years and more than 5 years, sputum AFB smear negative response to retreatment was 87%, 76%, 65% and 55%, respectively. 5) Adverse reaction to prothionamide, with complaints of gastrointestinal troubles was common and hepatic dysfunction without jaundice was observed in 7 percent, convulsion in 1 percent, that to cycloserine occurred renal dysfunction & psycosis & convulsion, 2%, 1%, 1%, respectively. Tinnitus with KM occurred in 1% and dirrhea with OFX in 4%. Conclusion: The duration of patient's illness was shorter, sputum AFB smear negative response rate was better. Radiologic responses were not remarkable, but extent of disease by national tuberculosis association was smaller, the result of retreatment was better. Adverse reaction of the secondary antituberculosis agent was mainly observed gastrointestinal troubles, as regard to tolerance to the secondary drugs the role of the physician is of very important value and toxic effects can be overcome by the strong confidence.

• 대한예방의학회:학술대회논문집
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• 2002.10a
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• pp.533-533
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• 2002

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.325-333
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• 2001

Background : This study aimed to estimate the clinical outcome and identify the characteristics of a group of patients with pulmonary tuberculosis who completed anti-tuberculosis therapy with the First-line drugs in spite of having positive smear results with negative sputum culture results over the previous six months. Method : A retrospective chart review of 21 patients who fulfilled the above criteria between 1995 and 1999 was performed. The laboratory data as well as the clinical data of the patients with positive smear results and negative culture results over a six months period were reviewed. Results : The negative conversion of sputum culture results was achieved within $1.3{\pm}1.2$ months and the negative conversion of the sputum smear results was accomplished during $9.5{\pm}3.3$ months. Chest X-rays at 5 months following the institution of anti-tuberculosis therapy from all patients revealed improvements. Four out of 21 patients(19%) relapsed during the follow up, $15.2{\pm}13.4$ months after administering anti-tuberculosis therapy for $13.3{\pm}3.1$ months. Relapses were confirmed from between 3 months and 4 months after the treatment completion. Only one of the four relapses had no past history of anti-tuberculosis therapy and the others had prior treatment twice (p<0.01). The period of anti-tuberculosis treatment was extended to a mean of $4.6{\pm}2.6$ months in 12 patients. However, prolongation of anti-tuberculosis therapy had no affect on the relapse rate (odds ratio, 95% CI 0.18, 2.15). Conclusion : Prolongation of therapy with the First-line drugs is not necessary for patients with persistently positive smear results over 6 months and negative culture results. A patient who has had prior anti-tuberculosis therapy more than twice should be paid the closest attention.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.287-293
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• 1999

Background: Medical treatment of multiple drug resistant(MDR) pulmonary tuberculosis has been quite unsuccessful. We analyzed our experience to identify the benefits and complications of the pulmonary resection in MDR pulmonary tuberculosis. Material and Method: A retrospective review was performed in 27 patients who unerwent pulmonary resection for MDR pulmonary tuberculosis between January 1994 and March 1998. Mean age was 40 years and the average history of diagnosis prior to surgery was 3.1 years. All had resistance to an average of 4.4 drugs, and received second line drugs selected according to the drug sensitivity test. Most patients (93%) had cavitary lesions as the main focus. Bilateral lesions were identified in 19 patients (70%), however, the main focus was recognized in one side of the lung. Eleven patients (41%) were converted to negative sputum smear and/or culture before surgery. Result: Pneumonectomy was performed in 9 patients, lobectomy in 16 and segmentectomy in 2. There was no operative mortality. Morbidity had occurred in 7 patients (26%), prolonged air leak in 3 patients, reoperation due to bleeding in 2, bronchopleural fistula in 1, and reversible neurologic defect in 1. Median follow up period was 15 months (3-45 months). Sputum negative conversion was initially achieved in 22 patients (82%), and with continuous postopertive chemotherapy negative conversion was achieved in other 4 patients (14%). Only one pneumonectized patient (4%) failed due to considerable contralateral cavity. Conclusion: For patients with localized MDR pulmonary tuberculosis and with adequate pulmonary reserve function, surgical pulmonary resection combined with appropriate pre and postoperative anti-tuberculosis chemotherapy can achieve high success rate with acceptable morbidity.

• Tuberculosis and Respiratory Diseases
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• v.39 no.2
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• pp.167-171
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• 1992

Background:In the management of patients whose primary chemotherapy has failed, very careful assessment is essential. It is important to find out as accurate a chemotherapy history as possible. Preferably it should contain the drugs which has never used before. The present report concerns the results of retreatment of pulmonary tuberculosis patients treated at National Kongju Tuberculosis Hospital. Method: A retrospective study was made through the regular follow-up of 112 smear positive cases, who were treated by four-drug regimen between July 1985 and June 1990. Four drugs were, namely prothionamide, cycloserine, para-aminosalicylic acid, and streptomycin (kanamycin or tuber-actinomycin). The duration of follow-up was over one year. Results: 1) Out of 112 cases with positive sputum AFB smear, 72 (64%) achieved the negative conversion. 2) Among the 72 patients, 85% achieved negative conversion within 3 months after treatment. 3) When the duration of patient's illness was less than 2 years, 2 to 4 years and more than 5 years, the favourable response to retreatment was 86%, 62% and 54%, respectively. 4) When the number of sensitive drugs was 4,3,2 and 1, the favourable response rate was 74%, 68%, 39% and 0%, respectively. Conclusion: The shorter the duration of patient's illness was, the larger the number of sensitive drugs was. And the larger the number of sensitive drugs was, the better the result of treatment was. Thus it is very crucial to successfully treat newly discovered patients with adequate regimens and proper case-holding.