August

結核 第 90 巻 第 8 号 2015 年 8 月 612

Abstract [Background] Nontuberculous mycobacteria (NTM)

are often detected in patients undergoing treatment for pulmo-nary tuberculosis. This clinical status is thought to represent NTM disease, contamination, or colonization, but discrimi-nating between these three conditions is diffi cult.

 [Purpose] We examined the clinical characteristics and pathogenicity of coexisting NTM among patients with pul-monary tuberculosis, as well as its impact on clinical practice.  [Patients and Methods] The subjects comprised 59 patients with pulmonary tuberculosis treated at the National Hospital Organization Utsunomiya National Hospital between January and December 2013. Patients in whom NTM was detected in one or more cultures were defi ned as the NTM group (19 patients), and they were compared to the non-NTM group (40 patients). Antiglycopeptidolipid (anti-GPL) core antibody titers were investigated in 18 patients from the NTM group.  [Result] We observed no signifi cant difference in patient characteristics (age, sex, complications, history of pulmonary tuberculosis, lung disease, chest imaging fi ndings, degree of smear positivity on admission) between the two groups. Mean duration of hospitalization was markedly longer for the NTM group, excluding those with coexisting NTM after

discharge (98.8±7.9 days), than for the non-NTM group (58.3 ±3.5 days ; p＜0.001). No anti-GPL core antibodies were detected in any of the 18 patients from the NTM group, including 13 patients who fulfi lled the ATS/IDSA criteria.  [Conclusion] Coexisting NTM observed during treatment for tuberculosis likely results from colonization or contam-ination and usually has low pathogenicity. However, this fi nding is related to prolonged hospitalization.

Key words : Nontuberculous mycobacteria, Pulmonary

tu-berculosis, Pathogenicity, Hospitalization, Antiglycopepti-dolipid core antigen IgA antibodies

1_{Department of Respiratory Medicine,} 2_{Department of} Clini-cal Laboratory, National Hospital Organization Utsunomiya National Hospital, 3_{Department of Pulmonary Medicine, and} Clinical Immunology, Dokkyo Medical University

Correspondence to : Otohiro Katsube, Department of Respi-ratory Medicine, National Hospital Organization Utsunomiya National Hospital, 2160 Shimo-okamoto, Utsunomiya-shi, Tochigi 329_1193 Japan. (E-mail: 5okatsube@gmail.com) −−−−−−−−Original Article−−−−−−−−

IMPACT OF COEXISTING NONTUBERCULOUS MYCOBACTERIA DURING

THE TREATMENT OF PULMONARY TUBERCULOSIS

1_{Otohiro KATSUBE,} 3_{Yasuko KIKKAWA,} 3_{Hidenori TAKIZAWA,} 1, 3_{Isano HASE,} 1, 3_{Hiroko MORITA,} 1, 3_{Yushi NOMURA,} 2_{Keisuke OGAWA, and} 1, 3_{Toshio NUMAO}

結核 第 90 巻 第 8 号 2015 年 8 月 618

Abstract [Setting] Delay in seeking care is one of the critical

issues in tuberculosis (TB) control among homeless persons in Japan. Yet knowledge of and attitude towards TB among homeless persons have remained unclear and limited efforts have been made to disseminate information related to TB among homeless persons.

 [Objective] To evaluate the effect of TB leafl ets, produced and distributed to homeless persons by a group of ex-homeless TB patients, and to understand what homeless persons know about TB.

 [Design] Self-administered questionnaire was conducted among homeless persons before and after distribution of the TB leafl ets. Changes in the responses to each question were also subjected to principal component analysis to group questions into types according to response patterns and iden-tify constructs of TB-related knowledge.

 [Results] Results of 88 participants were analyzed. TB knowledge score related to risks and symptoms signifi cantly improved after the intervention (from 54.3％ to 70.6％, p＜ 0.05), while knowledge on treatment cost did not. Two components were identifi ed, namely, the improvement in

TB impression and improvement in TB knowledge .

 [Conclusion] TB leafl ets were effective in improving certain aspects of TB knowledge. However, its effect on knowledge regarding treatment cost, which may be crucial in improving delay, was limited and thus the messages need to be revised.

Key words : Knowledge survey, Education,

Socio-economi-cally deprived persons, Homeless persons

1_{Department of Epidemiology and Clinical Research, Research} Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 2_{Department of Health, Shinjuku City Public Health Center,} 3_{Research Institute of Tuberculosis, Japan Anti-Tuberculosis} Association

Correspondence to : Lisa Kawatsu, Department of Epidemi-ology and Clinical Research, Research Institute of Tubercu-losis, Japan Anti-Tuberculosis Association, 3_1_24, Matsu-yama, Kiyose-shi, Tokyo 204_8533 Japan.

(E-mail: kawatsu@jata.or.jp) −−−−−−−−Original Article−−−−−−−−

EFFECT OF EDUCATIONAL LEAFLETS ON KNOWLEDGE AND ATTITUDE

TO TUBERCULOSIS AMONG HOMELESS PERSONS IN TOKYO, JAPAN

1_{Lisa KAWATSU,} 1_{Kazuhiro UCHIMURA,} 2_{Hiroyuki WATABE,} 2_{Sumi KAGURAOKA,} 2_{Yuka KUBOTA,} 2_{Marie SAKAKIBARA, and} 3_{Nobukatsu ISHIKAWA}

調査. 日本歯科衛生学会雑誌. 2008 : 2 ; 19 28. 18） Sasaki Y, Ohno K: Knowledge, attitude and behavior

con-cerning tuberculosis and living conditions of the homeless people. ICN. 2007. (20070630).

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Prompt Diagnosis of M. kansasii / M. Mori et al. 623

Abstract A 59-year-old man with chronic obstructive

pul-monary disease and bronchial asthma presented at our hospital with an abnormal shadow on the chest radiograph, which was obtained as part of a routine medical examination. Computed tomography of the chest revealed two nodules in the right upper lung with the longest diameter measuring 29 mm and 10 mm, respectively. A granulomatous disease was strongly suspected based on the histological features of the transbron-chial lung biopsy specimen. Results of smear examination for mycobacteria and genetic examination of the bronchial lavage aspirate by the transcription reverse transcription concerted (TRC) reaction method for Mycobacterium tuber-culosis and M.avium complex (MAC), were both negative. However, three days after the bronchoscopic examination, an additional genetic examination by the TRC method confi rmed the diagnosis of M.kansasii infection. About two weeks later, the culture results were positive and M. kansasii infection was re-confi rmed with the DNA probe method. The patient responded well to treatment with a combination of isoniazid, rifampicin, and ethambutol. In Japan, among the

nontubercu-lous mycobacterial infections, the prevalence of pulmonary M.kansasii disease is second only to infection with MAC. However, it is often diffi cult to distinguish this disease from pulmonary tuberculosis. In this patient, a genetic examination with the TRC method enabled a prompt diagnosis of M.kan-sasii infection. The TRC method appears to be a useful tool for diagnosing nontubercular mycobacterial infections.

Key words: Nontuberculous mycobacteria, M.kansasii, TRC

method, Bronchial lavage, Nodular shadow

1_{Department of Respiratory Medicine,} 2_{Devision of Clinical} Laboratory, National Hospital Organization Toneyama Na-tional Hospital

Correspondence to : Masahide Mori, Department of Respi-ratory Medicine, National Hospital Organization Toneyama National Hospital, 5_1_1, Toneyama, Toyonaka-shi, Osaka 560_8552 Japan. (E-mail: mmori@toneyama.go.jp) −−−−−−−−Case Report−−−−−−−−

THE GENETIC EXAMINATION OF BRONCHIAL LAVAGE ENABLES THE PROMPT

DIAGNOSIS OF PULMONARY MYCOBACTERIUM KANSASII ―A CASE REPORT

1_{Masahide MORI,} 1_{Fumitaka AGESHIO,} 1_{Hiroyuki KAGAWA,} 1_{Yohei OSHITANI,} 1_{Takeya FUJIKAWA,} 2_{Haruko SAITO,} 2_{Hajime SAKO,} 1_{Yukihiro YANO,}