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結核 第 93 巻 第 8 号 2018 年 8 月 472 文   献 1 ) 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. 2 ) 戸田宏文, 山口逸弘, 鹿住祐子, 他:環境由来 Myco-bacterium lentifl avumに対するコバス TaqMan MAI 偽陽 性反応の検討. 感染症学雑誌. 2013 ; 87 : 215 217. 3 ) 新妻一直, 斎藤美和子, 小柴静子, 他:マトリックス 支 援 レ ー ザ ー 脱 離 イ オ ン 化 飛 行 時 間 型 質 量 分 析 法 (MALDI-TOF MS)による抗酸菌の同定 ― 臨床分離抗 酸菌株と基準菌株を用いて. 結核. 2014 ; 89 : 555 563. 4 ) 日本結核病学会抗酸菌検査法検討委員会:「抗酸菌検 査ガイド 2016」. 財団法人結核予防会, 東京, 2016. 5 ) 鈴木弘倫, 吉田 敦, 樽川友美, 他:比較的稀な非結 核性抗酸菌臨床株を対象とし MALDI-TOF MS による 同定性能の評価. 日本臨床微生物学雑誌. 2016 ; 26 : 105 111. 6 ) 米 丸  亮, 加 藤 康 子, 豊 田  丈, 他: 臨 床 検 査 へ の MGIT 法導入による抗酸菌培養陽性率および培養陽性 者数の増加. 日呼吸会誌. 2002 ; 40 : 350 354.

Abstract [Objective] The frequency of misidentifi cation as

Mycobacterium lentifl avum strain in M.intracellulare strain identifi ed by TaqMan test was examined by using mass spectrometry.

 [Method] 70 clinically isolated nontuberculous mycobacte-ria preserved from 2001 were used. Measurement was carried out by mass spectrometry by the pretreatment method based on the mycobacteria test guide 2016.

 [Results] Among clinically isolated nontuberculous myco-bacteria strains, the COBAS Amplicor® method (Amplicor

method) identifi ed 5 strains and TaqMan test identifi ed 20 strains of M.intracellulare. Two strains of M.lentifl avum identifi ed by mass spectrometry were the ones misidentifi ed by TaqMan test. All other strains were equally identifi ed by mass spectrometry although the Amplicor method showed a Score Value of less than 1.7 for 2 strains.

 [Conclusion] The frequency of isolation of M.lentifl avum was 3.9% (2.9% for all 70 strains) for 2 out of 51 strains measured by the TaqMan method. Although there may be a

regional difference in the isolated frequency of M.intracel-lulare, there is a regional difference in the frequency of M. intracellulare isolation with a high necessity of treatment, but for the determination of nontuberculous mycobacteria including M.lentifl avum with low separation frequency, it is thought that identifi cation by mass spectrometry is important.

Key words: Mass spectrometry, COBAS TaqMan MAI test,

Mycobacterium intracellulare, Mycobacterium lentifl avum

1Inspection Department, Fukushima Prefectural Minami Aizu

Hospital, 2Department of Infectious Diseases and Pulmonary

Medicine, Fukushima Prefectural Medical University Aizu Medical Center

Correspondence to: Shizuko Koshiba, Inspection Department, Fukushima Prefectural Minami Aizu Hospital, 14_1, Kaza-shimo, Nagata, Minamiaizu-machi, Fukushima 967_0006 Japan. (E-mail: koshiba1024@gray.plala.or.jp)

−−−−−−−−Short Report−−−−−−−−

IDENTIFICATION SIGNIFICANCE USING MASS SPECTROMETRY OF

MYCOBACTERIUM LENTIFLAVUM

ERRONEOUSLY IDENTIFIED AS

MYCOBACTERIUM INTRACELLULARE

BY THE COBAS TaqMan MAI TEST

1Shizuko KOSHIBA, 2Katsunao NIITSUMA, 2Miwako SAITO, and 2Tomoko SUZUKI

7 ) 戸田宏文, 山口逸弘, 鹿住祐子, 他:採痰ブース内水 道水を介した Mycobacterium lentifl avum による Pseudo-Outbreak の 分 子 疫 学 的 解 析. 環 境 感 染 誌. 2013 ; 28 : 319 324.

8 ) 斎藤 肇, 村上和保, 矢島幹久, 他:新たに記載され た遅発育抗酸菌種のマウスに対する毒力. 結核. 2000 ; 75 : 65 69.

9 ) Tortoli E, Bartoloni A, Erba ML, et al. : Human infections due to Mycobacterium lentifl avum. J Clin Microbiol. 2002 ; 40 : 728 729.

10 ) Iwamoto T, Sonobe S, Hayashi K, et al. : A chronic pulmo-nary disease caused by Mycobacterium lentifl avum in a patient with a history of pulmonary tuberuculosis. Clin Microbiol Newsl. 2003 ; 25 : 79.

11 ) 開 陽子, 大河内康実, 徳田 均:検体の遺伝子学的 解析で診断しえた Mycobacterium lentifl avum 肺感染症の 1 例. 結核. 2012 ; 87 : 713 718.

12 ) 河田典子, 河原 伸, 多田敦彦, 他:BrothMIC NTM を 用いた非結核性抗酸菌の薬剤感受性についての検討. 結核. 2006 ; 81 : 329 335.

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M.shinjukuense with PMR / Y. Maeda et al. 477

Abstract A 72-year-old woman was referred to our

hospi-tal for the management of sustained cough and sputum. Ten years before the visit, she presented with an abnormal chest shadow and was regularly followed up as old pulmonary tuberculosis. At the age of 70 years, she was suffered from polymyalgia rheumatica and was administered steroid thera-py. After starting steroid therapy, the lung shadow expanded rapidly and formed a cavity. Although the cavitary shadow slightly improved after the steroid dose was decreased, coughing and sputum persisted. Mycobacteria were cultured from her sputum repeatedly, but the species could not be identifi ed using the DNA-DNA hybridization (DDH) method. However, analysis of DNA-directed RNA subunit beta (rpoB), 16S rRNA and hsp65 gene sequences revealed Mycobacte-rium shinjukuense. Following the diagnosis of pulmonary M.shinjukuense disease, we administered combination che-motherapy with isoniazid (INH), rifampicin (RFP), and clar-ithromycin (CAM) based on previous reports and her compli-cation of advanced glaucoma. After 8 weeks, we changed the treatment regimen to RFP, CAM and levofl oxacin (LVFX),

because of INH induced liver dysfunction. She completed the 18-months course of chemotherapy and her imaging and clinical fi ndings improved without recurrence. This is the fi rst case of pulmonary M.shinjukuense disease wherein the patient had been taking immunosuppressive agents such as steroid.

Key words : Mycobacterium shinjukuense, Polymyalgia

rheu-matica, Steroid

1Department of Internal Medicine, and 2Department of

Respiratory Medicine, Kawasaki Municipal Ida Hospital;

3Antimicrobial Resistance Research Center, National Institute

of Infectious Disease; 4Research Institute of Tuberculosis,

Japan Anti-Tuberculosis Association

Correspondence to: Kazumi Nishio, Department of Respira-tory Medicine, Kawasaki Municipal Ida Hospital, 2_27_1, Ida, Nakahara-ku, Kawasaki-shi, Kanagawa 211_0035 Japan. (E-mail: nishio-k@city.kawasaki.jp)

−−−−−−−−Case Report−−−−−−−−

A CASE OF PULMONARY MYCOBACTERIUM SHINJUKUENSE DISEASE

WITH POLYMYALGIA RHEUMATICA

1Yutaro MAEDA, 2Kazumi NISHIO, 2Kenichi ARAKAWA, 2Ryosuke ARAI, 2Shinji AIDA, 2Yasushi NAKANO, 2Junko KAGYO, 3Yuko KAZUMI,

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Review for Carbon Dioxide and TB / H. Furuya 483

9 ) Pankhurst LJ, Anaraki S, Lai KM: Combining environmental assessment and contact investigations to make tuberculosis screening decisions. Int J Tuberc Lung Dis. 2012 ; 16 : 1023 9.

10) Wang HY, Wang KC, Tsai SH, et al.: A Tuberculosis Outbreak at a Workplace in Central Taiwan, 2016. Taiwan Epidemiology Bulletin. 2018 ; DOI : 10.6525/TEB. 2018 02_34 (4). 0001

11) Andrews JR, Morrow C, Wood R: Modeling the role of public transportation in sustaining tuberculosis transmission in South Africa. Am J Epidemiol. 2013 ; 177 : 556 61.

12) Taylor JG, Yates TA, Mthethwa M, et al.: Measuring ventilation and modelling M.tuberculosis transmission in indoor congregate settings, rural KwaZulu-Natal. Int J Tuberc Lung Dis. 2016 ; 20 : 1155 61.

13) Wood R, Morrow C, Ginsberg S: Quantifi cation of shared air: a social and environmental determinant of airborne disease transmission. PLoS One. 2014; 9: e106622.

14) Hella J, Morrow C, Mhimbira F, et al.: Tuberculosis trans-mission in public locations in Tanzania: A novel approach to studying airborne disease transmission. J Infect. 2017 ; 75 : 191 197.

Abstract It has been well known that insuffi cient room

ventilation increased tuberculosis (TB) infection risk. Less number of studies linking between ventilation rates and TB infection risk has been reported. This paper reviews the recent literatures linking the CO2 concentration by exhaled air and TB

airborne infection. The accumulation of CO2 production by

active TB patients means both the increase of TB infectivity and the lower room ventilation rates. From the previous stud-ies, measuring CO2 concentration in the closed space where

TB outbreak occurred, is considered to be useful for identi-fying environmental infection risk.

Key words : Carbon dioxide,Mathematical model,Room

ventilation

Basic Clinical Science and Public Health, Tokai University School of Medicine

Correspondence to: Hiroyuki Furuya, Basic Clinical Science and Public Health, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa 259_1193 Japan. (E-mail: furuya@is.icc.u-tokai.ac.jp)

−−−−−−−−Review Article−−−−−−−−

REVIEW OF THE RELATIONSHIP BETWEEN

INDOOR CARBON DIOXIDE AND ROOM VENTILATION

FOR THE PURPOSE OF ESTIMATING TUBERCULOSIS INFECTION RISK

Hiroyuki FURUYA

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Quantitative Evaluation of Infectious Risk Factor of TB / M. Koike et al. 491

Abstract [Objectives] The present retrospective study

aimed to clarify the validity of quantitative analysis for infectious risk factors (IRF) of contact health examination (CHE) for tuberculosis at 3 types of institutes.

 [Subjects and Methods] We analyzed data from 140 (188) individuals who underwent CHE, included 10 patients that occurred at hospitals, care facilities for the elderly, and offi ce workplaces in two local health and medical service areas. IRF measured based on radiographic imaging fi ndings, frequency/ duration of symptoms, fi ndings of sputum smears determined used Gaffky scale, and ability to walk freely, as well as occupation, contact duration, contact area, with or without medical care, and with or without wearing mask, were quan-titatively divided into two or three grades. A rate of positive judgment of QFT-3G (p-QFT) of each institute or occupation, correlations between the degree of IRF and p-QFT, or a predictive factor for p-QFT were examined.

 [Results] The p-QFT rate was signifi cantly higher in the general offi ce workplace or non-caregiver, and there was no medical profession with p-QFT. The rate of p-QFT signifi cantly

correlated with the contact at closed space, one contact time over 30 minutes, ability to walk freely, longer duration of contact, and without wearing mask.

 [Conclusions] The range of contact health examination for tuberculosis might be determined via a quantitative evalua-tion of IRF.

Key words : QFT-3G, Contact health examination,

Tuber-culosis, Infectious risk factor, Infectious disease, Institute

1Agatsuma Health and Welfare Offi ce, Gunma Prefecture, 2

ex-Agatsuma Health and Welfare Offi ce, Gunma Pref., 3Division

of Health Prevention, Department of Health and Welfare, Gunma Pref., 4Shibukawa Health and Welfare Offi ce, Gunma

Pref., 5Isesaki Health and Welfare Offi ce, Gunma Pref.

Correspondence to: Mikiyoshi Koike, Agatsuma Health and Welfare Offi ce, Gunma Prefecture, 183_1, Nishinakanojyo, Nakanojyo-machi, Agatsuma-gun, Gunma 377_0425 Japan. (E-mail: koike-mik@pref.gunma.lg.jp)

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

QUANTITATIVE EVALUATION OF INFECTIOUS RISK FACTOR OF

CONTACT HEALTH EXAMINATION FOR TUBERCULOSIS

−RETROSPECTIVE STUDY−

1Mikiyoshi KOIKE, 2Yukio TOMIZAWA, 3Nobuyuki SAKURAI, 4Yasuyuki KONDOU, 3Satoshi TSUKUI, and 5Atsushi TAKAHASHI

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