• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.705-713
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• 1998

Background: An association between diabetes and tuberculosis has long been implied. The severity of diabetes appears to correlate with the degree of tuberculous activity. Methods: A retrospective chart review of 82 patients with active pulmonary tuberculosis in diabetics (DMTB) and 83 patients with active pulmonary tuberculosis in nondiabetics (Non-DMTB) admitted to the Kyung Hee Medical Center between January 1995 and December 1996 was underiaken. Results: The sex ratio of DMTB was 58 : 24, and that of Non-DMTB was 62 : 21. Male patients predominated in both groups. The highest incidence of DMTB was 6th and 7th decades and that of Non-DMTB was 3rd and 4th decades. In case which the tuberculosis developed after diagnosis of diabetes, the prevalence of pulmonary tuberculosis was the highest in diabetes for 5-10 years. On chest X-ray findings, the moderate advanced tuberculosis cases were the most common (60.9% in DMTTB and 50.6% in Non-DMTB). There was no relation between the degree of tuberculosis activity on chest x-ray(minimal, moderate, and far advanced tuberculosis) and presence of diabetes. The incidence of lower lung field tuberculosis in DMTB was significantly higher than Non-DMTB(p<0.05). The multiple lobe involvement was the predominant chest roentgenographic finding in both groups. There was no significant difference of treatment response between DMTB and Non-DMTB. There was no relationship between initial HbA1c and the severity of pulmonary tuberculosis on chest X-ray. During treatment of pulmonary tuberculosis in excellently and well controlled diabetes, the cure rate of pulmonary tuberculosis was significantly higher than the poorly controlled diabetes and the rate of treatment failure was significantly lower than poorly controlled diabetes. (p<0.05). Conclusion: Poor control of blood glucose is related with increased rate of treatment failure in pulmonary tuberculosis with diabetes mellitus. Further investigation will be needed to study the mechanisms of treatment failure in poorly controlled diabetics with pulmonary tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.201-206
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• 2016

Active tuberculosis (TB) has a greater burden of TB bacilli than latent TB and acts as an infection source for contacts. Latent tuberculosis infection (LTBI) is the state in which humans are infected with Mycobacterium tuberculosis without any clinical symptoms, radiological abnormality, or microbiological evidence. TB is transmissible by respiratory droplet nucleus of $1-5{\mu}m$ in diameter, containing 1-10 TB bacilli. TB transmission is affected by the strength of the infectious source, infectiousness of TB bacilli, immunoresistance of the host, environmental stresses, and biosocial factors. Infection controls to reduce TB transmission consist of managerial activities, administrative control, engineering control, environmental control, and personal protective equipment provision. However, diagnosis and treatment for LTBI as a national TB control program is an important strategy on the precondition that active TB is not missed. Therefore, more concrete evidences for LTBI management based on clinical and public perspectives are needed.

• Tuberculosis and Respiratory Diseases
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• v.79 no.1
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• pp.1-4
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• 2016

Tuberculosis (TB) remains a major public health problem in South Korea. The Joint Committee for the Development of Korean Guidelines for Tuberculosis published the Korean Guidelines for Tuberculosis in 2011 to provide evidence-based practical recommendations to health care workers caring for patients with TB in South Korea. After reviewing recent national and international scientific data on TB, the committee updated the Korean guidelines for TB in 2014. This article presents some practical issues related to the 2014 updated guidelines: namely use of the Mycobacterium tuberculosis-polymerase chain reaction assay and the Xpert MTB/RIF assay in the diagnosis of TB, as well as medical treatment for patients with multidrug-resistant TB.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.227-231
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• 2015

Background: Diagnostic methods for pulmonary tuberculosis (TB) have recently advanced. The aim of this study was to evaluate the changes in TB diagnostic tests that prompted the initiation of anti-TB treatment over time in South Korea, an industrialized country with an intermediate TB burden. Methods: Patients diagnosed with pulmonary TB in the first halves of 2005 and 2013 at a tertiary referral hospital were included. Diagnostic methods that prompted the initiation of anti-TB treatment were compared between the 2 groups of patients. Results: A greater proportion of patients were diagnosed with pulmonary TB using bronchoscopy in 2013 than in 2005 (26.7% vs. 6.6%, respectively; p<0.001), while the proportion of patients clinically diagnosed with pulmonary TB was lower in 2013 than in 2005 (24.7% vs. 49.0%, respectively; p<0.001). Additionally, more patients started anti-TB treatment based on positive polymerase chain reaction (PCR) results for Mycobacterium tuberculosis DNA in 2013 than in 2005 (47.3% vs. 7.9%, respectively; p<0.001). Conclusion: The initiation of treatment for pulmonary TB in South Korea has become more frequently based on PCR and the use of bronchoscopic specimens.

• Journal of Yeungnam Medical Science
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• v.37 no.4
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• pp.277-285
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• 2020

Tuberculosis (TB) is still a major health problem worldwide. Especially, multidrug-resistant TB (MDR-TB), which is defined as TB that shows resistance to both isoniazid and rifampicin, is a barrier in the treatment of TB. Globally, approximately 3.4% of new TB patients and 20% of the patients with a history of previous treatment for TB were diagnosed with MDR-TB. The treatment of MDR-TB requires medications for a long duration (up to 20-24 months) with less effective and toxic second-line drugs and has unfavorable outcomes. However, treatment outcomes are expected to improve due to the introduction of a new agent (bedaquiline), repurposed drugs (linezolid, clofazimine, and cycloserine), and technological advancement in rapid drug sensitivity testing. The World Health Organization (WHO) released a rapid communication in 2018, followed by consolidated guidelines for the treatment of MDR-TB in 2019 based on clinical trials and an individual patient data meta-analysis. In these guidelines, the WHO suggested reclassification of second-line anti-TB drugs and recommended oral treatment regimens that included the new and repurposed agents. The aims of this article are to review the treatment strategies of MDR-TB based on the 2019 WHO guidelines regarding the management of MDR-TB and the diagnostic techniques for detecting resistance, including phenotypic and molecular drug sensitivity tests.

• Journal of Yeungnam Medical Science
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• v.38 no.3
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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.

• Pediatric Infection and Vaccine
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• v.26 no.1
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• pp.32-41
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• 2019

Purpose: In order to prevent tuberculosis transmission early, it is important to diagnose and treat tuberculosis infection by investigating people who have contact with patients with active tuberculosis. Methods: From July 2014 to June 2017, the intrafamilial childhood contacts of the patients who were diagnosed with active tuberculosis at Chungnam National University Hospital were investigated for the presence of tuberculosis infection. We also retrospectively analyzed the treatment status of children treated with latent tuberculosis infection (LTBI) during the same period. Results: Among the 269 children who had intrafamilial contact with active tuberculosis patient, 20 (7.4%) did not receive any screening. At the first screening, one (0.4%) was diagnosed with pulmonary tuberculosis, seven (2.8%) had a previous history of tuberculosis infection, and 42 patients (16.9%) were diagnosed with LTBI. At the second screening, 29 patients (11.6%) were diagnosed with LTBI, and 61 patients did not finish the investigation. Only 188 (69.9%) out of 269 patients completed the investigation. Ninety patients received treatment for LTBI and 83 patients (92.2%) completed the treatment, of which 18 patients had side effects such as rash, fatigue, and gastrointestinal symptoms. However, there were no serious side effects requiring treatment discontinuation. Conclusions: The completion rate of childhood tuberculosis contact investigation was low, but the completion rate of LTBI treatment was high in children without serious side effects. In order to prevent and manage the spread of tuberculosis, active private-public partnership efforts and education of the patient and guardian are needed.

• Microbiology and Biotechnology Letters
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• v.49 no.2
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• pp.264-268
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• 2021

Tuberculosis (TB) is a major infectious disease that threatens the life and health of people globally. Here, we performed a metabolomic analysis of serum samples from patients with intractable TB to identify biomarkers that might shorten the TB treatment period. Serum samples collected at the commencement of patients' treatment and healthy controls were analyzed using the capillary electrophoresis and time-of-flight mass spectrometry metabolome analysis method. The analysis identified the metabolites cystine, kynurenine, glyceric acid, and cystathionine, which might be useful markers for monitoring the TB treatment course. Furthermore, our research may provide experimental data to develop potential biomarkers in the TB treatment course.

• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.443-449
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• 2004

• Tuberculosis and Respiratory Diseases
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• v.58 no.5
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• pp.431-437
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• 2005