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結核 第 90 巻 第 5 号 2015 年 5 月 502

Abstract [Objective] To evaluate the effi ciency of the

di-rect tuberculosis_loop-mediated isothermal amplifi cation (TB-LAMP) assay by using non-centrifuged sputum samples.  [Study Period and Methods] The study was conducted between June 2013 and February 2014. We collected 111 sputum samples from patients who had been radiographically diagnosed with tuberculosis and had not received any treat-ments for longer than 5 days. In the direct TB-LAMP assay, a loop-mediated isothermal amplifi cation kit and 60-μμL sputum samples were used. A direct smear microscopy test was used as the smear test. Then, the same sputum samples were processed with a CCE pretreatment reagent, and 100μμL of the solution samples were cultured by using the mycobacterial growth indicator tube (MGIT) culture method.

 [Results] Forty-six of the 111 samples were positive in the smear microscopy tests. All the smear-positive samples were positive in both the MGIT and direct TB-LAMP assay (100%). The mean positive detection time with the direct TB-LAMP assay was 13 minutes 55 seconds. Of 56 smear-negative and MGIT positive samples, 44 (78.6%) were judged to be positive

using the direct TB-LAMP assay, with a mean positive detection time of 15 minutes 59 seconds.

 [Discussion] The direct TB-LAMP assay using non-centri-fuged sputum samples was demonstrated to have a high detec-tion rate and thus may be considered useful for rapid and effective tuberculosis diagnosis.

Key words: Smear negative, MGIT positive, Rapid diagnosis

of tuberculosis, Molecular-based diagnostic test, Direct TB-LAMP

1Division of Laboratory, 2Division of Infection Diseases, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka Prefectural Hospital Organization

Correspondence to: Hiroko Yoshida, Osaka Prefectural Med-ical Center for Respiratory and Allergic Diseases, 3_7_1, Habikino, Habikino-shi, Osaka 583_8588 Japan.

(E-mail: yoshidahi@opho.jp) −−−−−−−−Original Article−−−−−−−−

STUDY OF DIRECT TB-LAMP USING NON-CENTRIFUGAL SPUTUMS

ABOUT EFFICIENCY FOR RAPID DIAGNOSIS OF TUBERCULOSIS

1Hiroko YOSHIDA, 1Kenichi ONOHARA, 1Tomomi TAZAWA, 1Kunimitsu KAWAHARA, 2Yuki TSURINAGA, 2Yuki HAN, 2Yoshitaka TAMURA, 2Takayuki NAGAI,

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結核 第 90 巻 第 5 号 2015 年 5 月 506

Abstract We report a case of a 75-year-old man with pleural

effusion and an occupational history of asbestos exposure. Fluorodeoxyglucose positron emission tomography‒computed tomography (FDG-PET/CT) examination revealed FDG up-takes along his pleura, leading to an initial suspicion of pleural mesothelioma. Pathological fi ndings of a diagnostic video-associated pleural biopsy showed epithelioid cell granuloma. Repeated sputum cultures were positive for Mycobacterium

intracellulare. The patient was diagnosed with pleuritis caused by non-tuberculous mycobacteria (NTM). NTM should be

considered a potential cause of pleuritis.

Key words : Non-tuberculous mycobacteriosis, Pleuritis,

Asbestos exposure, FDG-PET/CT

Department of Respirology, Ehime Prefecture Central Hospital Correspondence to : Norihiko Nakanishi, Ehime Prefecture Central Hospital, 83 Kasuga-cho, Matsuyama-shi, Ehime 790_ 0024 Japan. (E-mail: c-nakanishi@eph.pref.ehime.jp) −−−−−−−−Case Report−−−−−−−−

A CASE OF NON-TUBERCULOUS MYCOBACTERIOSIS

WITH PLEURAL EFFUSION AND THICKENING IN A PATIENT WITH

AN OCCUPATIONAL HISTORY OF ASBESTOS EXPOSURE

Norihiko NAKANISHI, Masaaki SHIOJIRI, Kouji INOUE, and Tomonori MORITAKA

別は画像所見では困難である8)。中皮腫は病理所見が, 抗酸菌感染症では細菌検査が必須である。 アスベストに関連した肺合併症として胸膜中皮腫や肺 癌が多いが,珪肺と違い抗酸菌症の合併の報告は少な い9)。われわれの検索した範囲でも奥田ら10)の報告がみ られたのみであった。アスベスト曝露歴と NTM による 胸膜炎は偶然合併した可能性はあるが,両者とも今後増 加の見込まれる疾患であり,確定診断には注意が必要で あると考えられた。

 著者の COI(confl ict of interest)開示:本論文発表内 容に関して特になし。 文   献 1 ) 市木 拓, 植田聖也, 渡邊 彰, 他:胸膜炎を合併し た肺非結核性抗酸菌症の検討. 日呼吸会誌. 2011 ; 49 : 885 _ 889. 2 ) 佐藤紀克, 中村保清, 北 英夫:肺非結核性抗酸菌症 に合併した胸膜炎の臨床的検討. 結核. 2014 ; 89 : 821 _ 824. 3 ) 石 黒  卓, 高 柳  昇, 齊 藤 大 雄, 他:Mycobacterium avium complex による胸膜炎の 2 例. 日呼吸会誌. 2010 ; 48 : 151 _ 156. 4 ) 日本結核病学会非結核性抗酸菌症対策委員会 , 日本呼 吸器学会感染症・結核学術部会:肺非結核性抗酸菌症 診断に関する指針―2008年. 結核. 2008 ; 83 : 525 _ 526. 5 ) Christensen EE, Dietz GW, Ahn CH, et al.: Pulmonary man-ifestations of Mycobacterium intracellularis. AJR. 1979 : 133 : 59 _ 66.

6 ) 門 政男:結核性胸膜炎.「結核」第 3 版, 泉 孝英, 網谷良一編, 医学書院, 東京, 1998, 200 _ 205.

7 ) Hammar SP, Dodson RF: Asbestos-induced pleural effusion. In: Dail and Hammar’s Pulmonary Pathology, 3rd ed. To-mashefski JF, ed., Springer Science + Business Media, LLC. New York, 2008, 979 _ 981.

8 ) 宇留賀公紀, 石原眞木子, 花田豪郎, 他:FDG-PET/CT が施行された抗酸菌症に関する検討. 結核. 2014 ; 89 : 39 _ 43.

9 ) Wagner GR: Asbestosis and silicosis. Lancet. 1997 ; 349 : 1311 _ 1315.

10) 奥田みゆき, 柏尾 誠, 田中順哉, 他:高濃度石綿暴 露があるため中皮腫を疑ったが , 胸膜炎を伴う非結核 性抗酸菌症であった 1 例. 日呼吸会誌. 2008 ; 46 : 655 _ 659.

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TB Annual Report 2013 (2) 521

−−−−−−−−Report and Information−−−−−−−−

TUBERCULOSIS ANNUAL REPORT 2013

─ (2) Tuberculosis in Pediatric and Elderly Patients ─

Tuberculosis Surveillance Center (TSC), RIT, JATA

Abstract In 2013, 66 patients with pediatric tuberculosis (TB; age range: 0_14 years) were newly notifi ed in Japan, corresponding to a notifi cation rate of 0.40 per 100,000 popu-lation. Since 2006, the annual number of notifi ed patients with pediatric TB has been less than 100. Among the 66 patients with pediatric TB who were notifi ed in 2013, 27 (40.9 %) were aged 0_4 years, 14 (21.2%) were aged 5_9 years, and 25 (37.9%) were aged 10_14 years. The largest propor-tion of pediatric TB patients was aged 0_4 years.

 In 2013, two cases of TB meningitis and no cases of miliary TB were reported in children. Case detection occurred at rates similar to previous years, with 20 patients (30.3%) identifi ed at medical institutions and 33 (50%) via household contact investigations.

 Since 2000, the number of all elderly patients (aged 65 years or older) with TB had decreased rapidly and remained stable until recently. However, the number of such patients has declined gradually since 2012. The proportion of TB patients aged 65 years or older has consistently increased to as high as 64.5% in 2013; notably, the proportion of TB patients aged 80 years or older has also increased to 36.1%. Since 1999, the TB notifi cation rates in Japan have been consistently higher among patients aged 85 years or older than among those aged 65_84 years. The rate of notifi cation for TB patients aged 65 years or older decreased by 0.6% from 2012 (13,307 patients) to 2013 (13,227 patients).

 The proportion of bacteriologically positive TB patients among the general population of pulmonary TB (PTB) patients was higher among those aged 65 years or older than among

those aged 15_64 years. Among all symptomatic patients, the proportion of PTB patients with only non-respiratory symp-toms increased with age to 30.3% among those aged 85 years or older. The proportion of TB patients with a patient delay of two months or longer was lower among patients aged 65 years or older than among those aged 15_64 years (14.2% vs. 25.6%), whereas the proportion of TB patients with a doctor delay of one month or longer was slightly higher among patients aged 65 years or older than among those aged 15_64 years (23.0% vs. 20.3%).

 Among TB patients aged 65 years or older who were newly notifi ed in 2012, 32.2% died within one year after the initia-tion of TB treatment; of these patients, 19.2% died within three months. Among patients aged 65 years or older, the proportion of deaths within three months after the initiation of TB treatment increased substantially with age from 7.8% of those aged 65_69 years to 37.7% of those aged 90 years or older.

Key words: Tuberculosis, Notifi cation rate, Pediatric tuber-culosis, Tuberculosis in the elderly, Annual trend

Research Institute of Tuberculosis (RIT), Japan Anti-Tuber-culosis Association (JATA)

Correspondence to: Tuberculosis Surveillance Center (TSC), Research Institute of Tuberculosis (RIT), JATA, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan.

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