• Tuberculosis and Respiratory Diseases
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• 제77권4호
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• pp.178-183
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• 2014

Here, we report a case of pulmonary paragonimiasis that was improved with initial anti-tuberculosis (TB) therapy but confused with reactivated pulmonary TB. A 53-year-old Chinese female presented with a persistent productive cough with foul smelling phlegm and blood streaked sputum. Radiologic findings showed subpleural cavitary consolidation in the right upper lobe (RUL). Bronchoscopic and cytological examination showed no remarkable medical feature. She was diagnosed with smear-negative TB, and her radiologic findings improved after receiving a 6-month anti-TB therapy. The chest CT scans, however, obtained at 4 months after completion of anti-TB therapy showed a newly developed subpleural consolidation in the RUL. She refused pathologic confirmation and was re-treated with anti-TB medication. Nevertheless, her chest CT scans revealed newly developed cavitary nodules at 5 months after re-treatment. She underwent thoracoscopic wedge resection; the pathological examination reported that granuloma caused by Paragonimus westermani. Paragonimiasis should also be considered in patients assessed with smear-negative pulmonary TB.

• Tuberculosis and Respiratory Diseases
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• 제83권1호
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• pp.20-30
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• 2020

Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only firs-tline drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient's condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB.

• 성인간호학회지
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• 제16권4호
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• pp.575-584
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• 2004

Purpose: To describe the performance in the health-promoting lifestyle and to identify the major factors affecting the health-promoting relationships between self care behaviors and health promoting lifestyle profile in patients with pulmonary tuberculosis. Method: A convenience sample for this study was 172 pulmonary tuberculosis patients who have taken TB medications in urban city. The HPLP-II was selected to measure the concept of health-promoting lifestyle because of the number of research studies conducted using both the original HPLP and the revised HPLP-II. The statistical methods used in this study were t-test, ANOVA, Pearson correlations, and multiple regression. Result: The differences of the HPLP-II were found to have a significance of age, marital status, education level, and health service center. The level of self care behaviors was related positively to the level of health promoting lifestyle and their subcategories. Based on stepwise multiple regression analysis, the model that predicted factors included self care behaviors, age, health service center and education. Conclusion: After decades of decreasing rates, TB has reemerged as a serious national problem in Korea. The careful clinical management and more national concern of TB may help to improve the outcomes of many patients. The findings of this study suggest that TB patients who are more fulfilled in health-promoting lifestyles and self-care behaviors may be able to make better decisions regarding positive health-promoting behaviors.

• Tuberculosis and Respiratory Diseases
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• 제67권2호
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• pp.127-130
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• 2009

Bilateral interstitial infiltration in chest radiography, which may be fine granular, reticular or of ground glass opacity, is the typical radiographic findings of Pneumocystis jiroveci pneumonia. Recently, atypical radiographic features, including cystic lung disease, spontaneous pneumothorax or nodular opacity, have been reported intermittently in patients with P. jiroveci pneumonia. We report the case of a 29-year-old woman with a transplanted kidney whose simple chest radiography and HRCT scan showed numerous miliary nodules in both lungs, mimicking miliary tuberculosis (TB). Under the presumptive diagnosis of miliary TB, empirical anti-TB medication was started. However, Grocott methenamine silver nitrate staining of a transbronchial lung biopsy tissue revealed P. jiroveci infection without evidence of TB. These findings suggest that even in TB-endemic area other etiology such as P. jiroveci as well as M. tuberculosis should be considered as an etiology of miliary lung nodules in mmunocompromised patients.

• Tuberculosis and Respiratory Diseases
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• 제70권2호
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• pp.125-131
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• 2011

Background: The clinical manifestation of $M.$ $tuberculosis$ infection ranges from asymptomatic latent infection, to focal forms with minimal symptoms and low bacterial burdens, and finally to advanced tuberculosis (TB) with severe symptoms and high bacillary loads. We investigated the diagnostic sensitivity of the whole-blood interferon-${\gamma}$ release assay according to the wide spectrum of clinical phenotypes. Methods: In patients diagnosed with active TB that underwent $QuantiFERON^{(R)}$ (QFT) testing, the QFT results were compared with patients known to be infected with pulmonary tuberculosis (P-TB) and extra-pulmonary TB (EP-TB). In addition, the results of the QFT test were further analyzed according to the radiographic extent of disease in patients with P-TB and the location of disease in patients with EP-TB. Results: There were no statistical differences in the overall distribution of QFT results between 177 patients with P-TB and 84 patients with EP-TB; the positive results of QFT test in patients with P-TB and EP-TB were 70.1% and 64.3%, respectively. Among patients with P-TB, patients with mild extents of disease showed higher frequency of positive results of QFT test than that of patients with severe form (75.2% vs. 57.1%, respectively; p=0.043) mainly due to an increase of indeterminate results in severe P-TB. Patients with TB pleurisy showed lower sensitivity by the QFT test than those with tuberculous lymphadenitis (48.8% vs. 78.8%, respectively; p=0.019). Conclusion: Although QFT test showed similar results between overall patients with P-TB and EP-TB, individual sensitivity was different according to the radiographic extent of disease in P-TB and the location of disease in EP-TB.

• Tuberculosis and Respiratory Diseases
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• 제61권5호
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• pp.440-446
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• 2006

연구배경: 감염증의 발생여부는 장기이식환자의 예후에 중요한 영향을 미친다. 국내와 같이 결핵의 유병률이 높은 지역에서는 장기이식후 기회감염으로 결핵 발병의 위험성이 높을 것으로 추정되나 아직 간 또는 심장이식환자에서의 결핵의 발병률 및 임상양상에 대한 보고가 부족하거나 없다. 방 법: 1992년 1월 부터 2004년 7월까지 서울아산병원에서 간 또는 심장이식을 받은 840명(간이식 730 예, 심장이식 110예)을 대상으로 의무기록을 후향적으로 분석하였다. 결 과: 국내의 한 대학병원에서 간이식 후 결핵의 발생률은 1.5% (추적 $26.6{\pm}19.8$개월), 심장이식은 2.7% (추적 $59.7{\pm}33.3$개월)였다. 이것은 과거 보고된 국내 신장이식 환자들에서의 결핵 유병률보다는 낮은 것으로 추정된다. 폐외결핵이 35% (속립성 결핵 14%)를 차지하여 기존의 보고들과 같이 폐외결핵의 발병률이 높았다. 간이식 환자에서 결핵발병의 위험인자는 단변수 분석에서 이식 후 당뇨, 낮은 이식 전 백혈구 수치, 만성거부반응이었고, HBeAg 양성은 경계수준의 유의성을 보였다. 대부분의 이식환자에서 결핵 예방 치료가 시행되지 않았고, 결핵이 발생한 대다수의 환자는 리팜핀을 포함한 1차 약제로 치료하였고, 항결핵치료와 연관된 급성 거부반응은 2예에서 관찰되었다. 결 론: 국내의 한 대학병원에서 간 또는 심장이식 후 결핵의 발생률은 각각 1.5%, 2.7%로 결핵의 유병률이 낮은 국가에서의 이식 후 결핵 발병률 보다 높았으며 폐외결핵이 많았다.

• Tuberculosis and Respiratory Diseases
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• 제49권4호
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• pp.432-440
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• 2000

연구배경 : 최근 고령자 폐결핵은 우리 나라 및 선진국에서 전반적인 인구의 고령화, 여러 가지 만성 소모성 전신질환과의 동반된 질환, 그리고 노인들의 집단 생활 및 빈곤, 면역 저하 등으로 인하여 65세 이상의 노인 층의 결핵 유병률은 증가하는 추세이다. 이에 저자 등은 고령자 폐결핵에 있어서의 임상적인 특정을 관찰하였다. 방법 : 1993년 5월부터 1998년 5월까지 국립의료원 흉부 내과에 입원하였던 65세 이상의 활동성 폐결핵 환자를 대상으로 하였다. 이들 폐결핵 환자는 총 92예 이었으며 이들에서의 성별분포, 증상, 동반된 질환, 진단, 항 결핵제 및 그 부작용 등에 관하여 임상적인 관찰하였다. 결과 : 1) 고령자 폐결핵 92예 중 남자 62예 여자 30예 였으며 남 여 비는 2.1:1이었다. 2) 내원 시 주 증상은 기침(47.8%), 호흡곤란(40.2%), 객담(38.0%), 흉통(12.0%), 식욕부진(10.9%), 발열(9.8%)등의 순이었다. 3) 폐결핵의 과거력이 있는 환자는 38예(41.3%), 과거력이 없는 환자는 54예(58.7%)이었다. 4) 폐결핵과 동반된 질환으로는 만성 폐쇄성 폐 질환 25예 (27.2%), 폐렴 17예(18.5%), 당뇨병 13예(14.1%), 악성종양 10예(10.9%) 등의 순이었다. 5) 결핵피부 반응검사 상 양성인 환자는 43예(82.7%), 음성인 환자 9예(17.3%)이었다. 6) 항산균 객담 도말 검사에서 39예(42.4%), 결핵균 객담 배양검사 14예(15.2%), 객담 TB PCR 10예(10.9%), 기관지 세척액 항산균 도말 검사 2예(2.1%)등에서 각각 양성이었으며 흉부 엑스선 검사로만 진단된 환자는 23예(25.0%)이었다. 7) 단순 흉부 엑스선상 병변의 부위는 우상폐야 50예, 우하폐야 50예로 가장 많았고 좌하폐야가 26예로 가장 적었다. 8) 동반된 폐외 결핵으로는 기관지 결핵 8예(8.7%), 결핵성 흉막삼출 7예(7.6%), 속립성 결핵 5예(5.4%), 장 결핵 2예(2.2%), 신 결핵 1예(1.1%) 이였다. 9) 1차 약으로 치료한 경우가 85예(92.3%)이었고, 2차약으로 치료한 경우 7예(7.6%)이었으며, 항 결핵제의 부작용으로는 INH 3예(말초 다발 신경염, 과만증, 오심), RFP 2예(혈소판감소증, 과민증), EMB 2예(시력감소, S-Cr 증가), PZA 2예(관절염, 간독성)이었다. 결론 : 고령자에서의 폐결핵은 기침, 객담, 호흡곤란 등 그 경미한 증상에 비하여 병변이 심하며, 전형적인 젊은층 폐결핵 환자와 다른 임상 상을 보이고 기타 만성 소모성 전신 질환과도 잘 동반된다. 따라서 고령자 폐결핵은 쉽게 발견되지 않거나 오진될 수도 있다.

• Tuberculosis and Respiratory Diseases
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• 제81권3호
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• pp.216-221
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• 2018

Background: The number of immigrants with tuberculosis (TB) increases each year in South Korea. Determining the transmission dynamics based on whole genome sequencing (WGS) to cluster the strains has been challenging. Methods: WGS, annotation refinement, and orthology assignment for the GenBank accession number acquisition were performed on two clinical isolates from Chinese immigrants. In addition, the genomes of the two isolates were compared with the genomes of Mycobacterium tuberculosis isolates, from two native Korean and five native Chinese individuals using a phylogenetic topology tree based on the Multiple Alignment of Conserved Genomic Sequence with Rearrangements (Mauve) package. Results: The newly assigned accession numbers for two clinical isolates were CP020381.2 (a Korean-Chinese from Yanbian Province) and CP022014.1 (a Chinese from Shandong Province), respectively. Mauve alignment classified all nine TB isolates into a discriminative collinear set with matched regions. The phylogenetic analysis revealed a rooted phylogenetic tree grouping the nine strains into two lineages: strains from Chinese individuals and strains from Korean individuals. Conclusion: Phylogenetic trees based on the Mauve alignments were supposed to be useful in revealing the dynamics of TB transmission from immigrants in South Korea, which can provide valuable information for scaling up the TB screening policy for immigrants.

• Tuberculosis and Respiratory Diseases
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• 제70권4호
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• pp.323-329
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• 2011

Background: Although patients with tuberculous-destroyed lung (TDL) account for a significant proportion of those with chronic airflow obstruction, it is difficult to distinguish patients with airway obstruction due to TDL from patients with pure chronic obstructive pulmonary disease (COPD) on initial presentation with dyspnea. We investigated clinical features differing between (i) patients with TDL and airway obstruction and (ii) those with COPD admitted to the intensive care unit (ICU) due to dyspnea. Methods: We reviewed the medical records of patients with TDL who had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% on a pulmonary function test (PFT; best value closest to admission) and patients with COPD without a history of pulmonary tuberculosis (TB) who were admitted to the ICU. Ultimately, 16 patients with TDL and 16 with COPD were compared, excluding patients with co-morbidities. Results: The mean ages of the patients with TDL and COPD were 63.7 and 71.2 years, respectively. Mean FVC% (50.4% vs. 71.9%; p<0.01) and mean FEV1% (39.1% vs. 58.4%; p<0.01) were significantly lower in the TDL group than in the COPD group. More frequent consolidation with TB (68.8% vs. 31.3%; p=0.03) and more tracheostomies (50.0% vs. 0.0%; p=0.02) were observed in the TDL than in the COPD group. Conclusion: Upon ICU admission, patients with TDL had TB pneumonia more frequently, more diminished PFT results, and more tracheostomies than patients with COPD.

• 대한의생명과학회지
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• 제20권3호
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• pp.162-167
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• 2014

Tuberculosis (TB) is one of the major global health problems and it has been estimated that in 5~10% of Mycobacterium tuberculosis (MTB)-infected individuals, the infection progresses to an active disease. Numerous cytokines and chemokines regulate immunological responses at cellular level including stimulation and recruitment of wide range of cells in immunity and inflammation. In the present study, the mRNA expression levels of eight host immune markers containing of IFN-${\gamma}$, TNF-${\alpha}$, IL-2R, IL-4, IL-10, CXCL9, CXCL10, and CXCL11 in whole blood cells from active pulmonary TB patients were measured after T-cell mitogen (PHA) and MTB specific antigens (ESAT-6, CFP-10, and TB7.7). Among the TH1-type factors, IFN-${\gamma}$ mRNA expression was peaked at 4 h, TNF-${\alpha}$ and IL-2R mRNA expression was significantly high at the late time points (24 h) in active TB patients, TH2-type cytokine (IL4 and IL10) mRNA expression levels in both active TB and healthy controls samples did not changed significantly, and the mRNA expression of the three IFN-${\gamma}$-induced chemokines (CXCL9, CXCL10, and CXCL11) were peaked at the late time points (24 h) in active TB patients after MTB specific antigen stimulation. In conclusion, the mRNA expression patterns of the TB-related immune markers in response to the T-cell mitogen (PHA) differed from those in response to MTB specific antigens and these findings may helpful for understanding the relationship between MTB infection and host immune markers in a transcripts level.