February

11 

全文

(1)

結核 第 91 巻 第 2 号 2016 年 2 月 32

Abstract [Purpose] The diagnosis of Mycobacterium avium complex pulmonary disease (MAC-PD) can be challenging. A serodiagnosis enzyme immunoassay (EIA) kit, which detects the serum anti-glycopeptidolipid (GPL) core IgA antibody, has been commercialized recently; however, its clinical use-fulness in the diagnosis of MAC-PD is still unclear. This study aimed to evaluate the availability of this kit and identify factors affecting testing accuracy.

 [Methods] We performed a retrospective study of 195 patients who were evaluated with an EIA kit at Nagasaki University Hospital between November 2012 and March 2014.  [Results] 12 of 16 (75.0%) MAC patients have underlying diseases ; 8 of 16 (50%) had complications associated with respiratory diseases. There were no signifi cant differences between the seropositive and seronegative background of patients with confi rmed MAC-PD. Regarding the accuracy of serodiagnosis EIA kit, its sensitivity and specifi city were 81.3% and 88.3% (with a cut-off value of 0.7 U/ml), respec-tively. Of false-positive patients with bronchiectasis, 28.6 % demonstrated a good response to anti-MAC treatment, indicating that the sensitivity of the EIA kit might be higher than that of culture-based diagnosis because patients with clinically diagnosed MAC-PD were included in the false-positive population.

 [Conclusions] In the current study, the serodiagnosis EIA kit demonstrated good sensitivity and specifi city for the diagnosis of MAC-PD. Further clinical investigations are necessary to clarify the role of this kit in defi nitively diag-nosing MAC infections.

Key words: Nontuberculous mycobacteria, Pulmonary MAC disease, Capilia® MAC, Serodiagnosis, Bronchiectasis 1Department of Respiratory Diseases, Nagasaki University

Hospital ; 2Unit of Molecular Microbiology and Immunology

Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences ; 3Department of

Laboratory Medicine, Nagasaki University Hospital, 4

De-partment of Chemotherapy and Mycoses, National Institute of Infectious Diseases ; 5Department of Clinical Infectious

Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences

Correspondence to : Shigeki Nakamura, Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1_ 23_1, Toyama, Shinjuku-ku, Tokyo 162_8640 Japan. (E-mail: shigekinak@nih.go.jp)

−−−−−−−−Original Article−−−−−−−−

SERODIAGNOSIS OF THE MYCOBACTERIUM AVIUM COMPLEX BY USING

IgA ANTIBODIES FOR THE GLYCOPEPTIDOLIPID CORE ANTIGEN

1, 5Yoshitsugu HIGASHI, 1, 4Shigeki NAKAMURA, 1Hiromi TOMONO, 1Shotaro IDE, 1Takahiro TAKAZONO, 1Taiga MIYAZAKI, 2Koichi IZUMIKAWA, 3Katsunori YANAGIHARA,

(2)

Foreign TB / HIV in Hokkaido / K. Ikeda et al. 39

Abstract [Background and Purpose] According to recent news, patients with concurrent tuberculosis (TB) and human immunodefi ciency virus (HIV) infection are increasingly common worldwide. This study aimed to investigate whether TB/HIV co-infected patients are visiting Hokkaido.

 [Method] We conducted a questionnaire survey regarding foreign patients infected with TB or TB/HIV who visited Hokkaido between January 2001 and September 2014. We mailed questionnaires to health centers, AIDS treatment care hospitals, and TB hospitals in Hokkaido prefecture.

 [Results] Seventy-one TB patients were of foreign natio-nality according to the answers obtained from health centers. Most of them were foreign students or occupational trainees between 20_30 years old. Approximately half these patients were from East Asia, and 7 patients were from Africa. As 21 % of the patients with TB who visited medical examination were over 1 month from disease onset, and the delay in visit-ing was recognized. The TB infection was mostly detected coincidentally during the physician visit. In the hospital

sur-vey, four TB patients with HIV were of foreign nationality. They were also of the age group from 20_30 years and hailed from sub-Saharan Africa.

 [Discussion] During immigration, medical examination by performing a chest radiograph is important. If the immigrant hails from an area where TB and HIV co-infection is common, it is necessary to confi rm whether HIV infection is present. Key words: Hokkaido, Foreigners, Tuberculosis, HIV infec-tion, AIDS, Internationalization

Department of Respiratory Medicine and Allergology, Sap-poro Medical University, School of Medicine

Correspondence to : Kimiyuki Ikeda, Department of Respi-ratory Medicine and Allergology, Sapporo Medical University, School of Medicine, South 1 West 16, Chuo-ku, Sapporo-shi, Hokkaido 060_8543 Japan. (E-mail: ikeda@sapmed.ac.jp) −−−−−−−−Original Article−−−−−−−−

THE CURRENT SITUATION OF FOREIGN TUBERCULOSIS PATIENTS

AND THEIR CONCURRENT HIV INFECTION IN HOKKAIDO

Kimiyuki IKEDA, Hirotaka NISHIKIORI, Shun KONDO, Tomofumi KOBAYASHI, Tetsuya TAYA, Yuki MORI, Makoto SHIOYA, Koji KURONUMA,

(3)

結核 第 91 巻 第 2 号 2016 年 2 月 44 文   献 1 ) 日本結核病学会非結核性抗酸菌症対策委員会:肺非結核 性抗酸菌症に対する外科治療の指針. 結核. 2008 ; 83 : 527 528. 2 ) 山田勝雄, 杉山燈人, 安田あゆ子, 他:肺非結核性抗酸 菌症に対する外科治療後の再燃//再発症例の検討. 結 核. 2013 ; 88 : 469 475.

3 ) Kitada S, Maekura R, Toyoshima N, et al.: Use of glycopep-tidolipid core antigen for serodiagnosis of Mycobacterium avium-complex pulmonary disease in immunocompetent patients. Clin Diagn Immunol. 2005 ; 12 : 44 51.

4 ) Kitada S, Nishiuchi Y, Hiraga T, et al.: Serological test and chest computed tomography fi ndings in patients with Mycobacterium avium-complex lung disease. Eur Respir J. 2007 ; 29 : 1217 1223.

5 ) Kitada S, Kobayashi K, Ichiyama S, et al.: Serodiagnosis of Mycobacterium avium-complex pulmonary disease using an enzyme immunoassay kit. Am J Respir Crit Care Med. 2008 ; 177 : 793 797.

6 ) Kitada S, Kobayashi K, Nishiuchi Y, et al.: Serodiagnosis

of pulmonary disease due to Mycobacterium avium-complex proven by bronchial wash culture. Chest. 2010 ; 138 : 236 237.

7 ) Kitada S, Levin A, Hiserote M, et al.: Serodiagnosis of Mycobacterium avium-complex pulmonary disease in the USA. Eur Respir J. 2013 ; 42 : 454 460.

8 ) Kitada S, Yoshimura K, Miki K, et al.: Validation of a commercial serodiagnostic kit for diagnosing pulmonary Mycobacterium avium-complex disease. Int J Tuberc Lung Dis. 2015 ; 19 : 97 103.

9 ) 林 悠太, 中川 拓, 小川賢二:MAC血清診断キット の実臨床データ解析. 第87回総会シンポジウム「増加 するMAC症の制御を目指して」. 結核. 2013 ; 88 : 364 367.

10) Kanda Y: Investigation of the freely available easy to use software EZR for medical statistics. Bone Marrow Trans-plant. 2013 ; 48 : 452 458.

11) 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. 結核. 2008 ; 83 : 525 526.

Abstract [Background] Patients receiving surgical treatment for Mycobacterium avium complex (MAC), lung disease should be followed up with careful attention paid to relapse/ recurrence, but there is some debate regarding the fi ndings based on which relapse/recurrence should be diagnosed.  [Purpose and Methods] We hypothesized that we might be able to use anti-GPL core IgA antibodies (MAC antibodies), which have been attracting attention as a factor that may support diagnosis of MAC lung disease, to diagnose postoper-ative relapse/recurrence. Therefore, we compared the levels of these antibodies before and at the time of relapse/recur-rence, and also compared antibody titers before and after surgery.

 [Result] MAC antibody titers were elevated by an average of about 50% at the time of relapse/recurrence compared to those before relapse/recurrence for 6 patients. In contrast, MAC antibody titers were about 30% lower after surgery compared to those before surgery for 37 patients.

 [Conclusion] It may be possible to use MAC antibodies

as an indicator of postoperative relapse/recurrence for MAC lung disease.

Key words : Anti-GPL core IgA antibody, MAC antibody,

Mycobacterium avium complex (MAC), Surgical treatment, Relapse, Recurrence

Departments of 1Thoracic Surgery, and 2Pulmonary Medicine,

National Hospital Organization Higashi Nagoya National Hospital;3Department of Thoracic Surgery, National Hospital

Organization Nagoya Medical Center;4Department of Quality

and Patient Safety, Nagoya University Hospital

Correspondence to: Katsuo Yamada, Department of Thorac-ic Surgery, National Hospital Organization Higashi Nagoya National Hospital, 5_101, Umemorizaka, Meito-ku, Nagoya-shi, Aichi 465_8620 Japan.

(E-mail: k123yamada@aol.com) −−−−−−−−Original Article−−−−−−−−

CHANGES IN MAC ANTIBODY LEVELS BEFORE AND AFTER SURGERY

AND AT THE TIME OF RELAPSE/RECURRENCE

IN MAC LUNG DISEASE

― Can MAC Antibodies Be an Indicator of Postoperative Relapse/Recurrence? ―

1Katsuo YAMADA, 3Yuuta KAWASUMI, 4Ayuko YASUDA, 3Yukio SEKI, 2Takashi ADACHI, 2Osamu TARUMI, 2Yuuta HAYASHI, 2Taku NAKAGAWA,

(4)

結核 第 91 巻 第 2 号 2016 年 2 月 48

Abstract [Purpose] QuantiFERON® TB-Gold In-Tube (3G)

testing was performed on tuberculosis-positive index cases and their contacts. The purpose of this study was to evaluate the relationship between 3G test results and the subsequent development of tuberculosis, and to identify effective strat-egies to prevent the onset of tuberculosis.

 [Methods] Index cases and their contacts were subjected to 3G testing in a contact investigation in Osaka City in 2011_ 2012. For index cases, sputum smears were tested, and the infecting organism was identifi ed. For the contacts, the fol-lowing information was collected: age, results of 3G testing, presence or absence of latent tuberculosis infection (LTBI) treatment, and onset of tuberculosis disease within 2 years of follow-up from the last contact with the index cases.  [Results] (1) There were 830 index cases, including 774 subjects with pulmonary tuberculosis (93.3%) and 3 with laryngeal tuberculosis (0.4%). From sputum smear tests, 726 patients (87.5%) were determined to be 3G positive, and 83 (10.0%) were determined to be 3G negative. (2) In total, 2,644 contacts were subjected to 3G testing. Of these, 2,072 patients (78.4%) tested negative, 196 (7.4%) showed an equivocal result, and 375 (14.2%) tested positive. Their mean ages were 33.7, 38.0, and 38.8 years, respectively, showing signifi cant

differences in tuberculosis status according to age (P< 0.001). (3) Among the 2,072 3G-negative contacts, tubercu-losis developed in 2 (0.1%) of 2063. None of these contacts was treated for LTBI. Among the 375 3G-positive contacts, tuberculosis developed in 36 (36.0%) of 100 subjects that were not LTBI treated, while tuberculosis developed in 3 (1.1 %) of 275 subjects that were LTBI treated. A signifi cant difference in the incidence of tuberculosis between treated and untreated 3G-positive contacts was observed (P<0.001).  [Discussion] Tuberculosis developed in a high proportion of 3G-positive contacts that were not LTBI treated, suggesting the need for preventive management of 3G-positive contacts. Key words: Pulmonary tuberculosis, Contact investigation, QFT-GIT, LTBI, Onset

1Osaka City Public Health Offi ce, 2Health Bureau, Osaka

City, 3Nishinari Ward Offi ce, Osaka City

Correspondence to: Kenji Matsumoto, Osaka City Public Health Offi ce, 1_2_7_1000, Asahimachi, Abeno-ku, Osaka-shi, Osaka 545_0051 Japan.

(E-mail: ke-matsumoto@city.osaka.lg.jp) −−−−−−−−Short Report−−−−−−−−

USE OF QuantiFERON

®

TB-GOLD IN-TUBE IN A CONTACT INVESTIGATION

TO DETERMINE THE ONSET OF TUBERCULOSIS

WITH OR WITHOUT LATENT TUBERCULOSIS INFECTION TREATMENT

1Kenji MATSUMOTO, 1Jun KOMUKAI, 1Yuko TSUDA, 1Kanae FURUKAWA, 1Kazumi SAITO, 1Satoshi HIROTA, 2Shinichi KODA, 3Sachi KASAI,

(5)

結核 第 91 巻 第 2 号 2016 年 2 月 52

Abstract [Purpose] In response to a case of endotoxin con-tamination of tubes used in QuantiFERON® TB Gold

(QFT-3G) testing in Japan in 2013, the effect of this contamination on QFT-3G test results was investigated.

 [Methods] We analyzed QFT-3G results from 4,258 par-ticipants in a tuberculosis contact investigation in Yamagata, Japan from September 2010 to April 2015. Of these, 2,488 samples were collected before the endotoxin contamination, while 1,770 samples were collected after the contamination.  [Results] Negative control values in the group tested after the contamination were signifi cantly lower than those in the group tested before the contamination (P<0.0005). The proportion of positive controls that exceeded the calculated limit (10 IU/ml) in the group tested after the contamination (87.8%) was lower than that in the group tested before the contamination (96.8%; P<0.0005). The proportion of intermediate results in the group tested after the contamination

(3.2%) was markedly lower than that in the group tested before the contamination (6.6%).

 [Discussion] Differences in QFT-3G test results were found to be related to a difference in blood collection before or after endotoxin contamination of blood collection tubes. Values resulting from QFT-3G testing were lower in blood samples that were collected after the contamination relative to those collected before the contamination.

Key words: QFT-3G, Endotoxin

Yamagata Prefectural Institute of Public Health

Correspondence to : Junji Seto, Department of Microbiology, Yamagata Prefectural Institute of Public Health, 1_6_6, Toka-machi, Yamagata-shi, Yamagata 990_0031 Japan.

(E-mail: setoj@pref.yamagata.jp) −−−−−−−−Short Report−−−−−−−−

COMPARISON OF QuantiFERON

®

TB GOLD TEST RESULTS

BEFORE AND AFTER ENDOTOXIN CONTAMINATION

Junji SETO, Yu SUZUKI, and Tadayuki AHIKO

謝   辞

 山形県内 4 保健所感染症予防担当のみなさまのデータ 精査への御協力に感謝申し上げます。また,検査データ を入力いただいた山形県衛生研究所,本田,栂瀬両氏に 深謝いたします。

 著者の COI(confl icts of interest)開示:本論文発表内 容に関して特になし。 文   献 1 ) 日本結核病学会予防委員会:インターフェロン γ 遊離 試験使用指針. 結核. 2014 ; 89 : 717_725. 2 ) 日本結核病学会:クォンティフェロン®TB ゴールド用 採血管の不具合への対応について. 2013. http://www. kekkaku.gr.jp/pdf/aninfo-qft20130430.pdf(平成 27 年 8 月 19 日閲覧) 3 ) 瀬戸順次, 阿彦忠之:接触者健康診断における高齢者 に対するインターフェロン-γ遊離試験の有用性の検討. 結核. 2014 ; 89 : 503_508. 4 ) 3G 採血管(エンドトキシン混入による新ロット報告) (2013 年 5 月 13 日). 一 般 社 団 法 人 免 疫 診 断 研 究 所. http://www.riid.or.jp/information/detail/3.html(平成27年 8 月 20 日閲覧)

5 ) Gaur RL, Suhosk MM, Banaei N: In vitro immunomodula-tion of a whole blood IFN-gamma release assay enhances T cell responses in subjects with latent tuberculosis infection. PLoS One. 2012 ; 7 : e48027.

(6)

M. abscessus Infection in Immunosuppression / H. Matsuse et al. 57

Abstract A 58-year-old man developed cough, sputum, and low-grade fever during immunosuppressive treatment with corticosteroids and cyclosporine for myasthenia gravis with recurrent thymoma. Since chest CT revealed diffuse nodular opacities in both lung fi elds, he was referred to our department. Mycobacterium abscessus was repeatedly cul-tured from his sputum, and he was diagnosed with pulmonary

M.abscessus infection. Although both chest radiological fi ndings and clinical symptoms were mild, he required treatment with immunosuppressive agents and systemic anesthesia for resection of the recurrent thymoma. Based on complications and according to the patient’s preference, oral treatment with clarithromycin 600 mg/day, levofl oxacin 500 mg/day, and faropenem 600 mg/day was initiated on an outpatient basis. Following these treatments, his chest CT fi ndings and clinical symptoms subsided, and the thymoma

was successfully resected. Our experience with the present case suggests a possible treatment strategy for M.abscessus infection in immunocompromised and complicated cases. Key words: Nontuberculous mycobacteriosis, Mycobacterium

abscessus, Myasthenia gravis

1Division of Respiratory Medicine, Department of Internal

Medicine, 2Department of Neurosurgery, Toho University

Ohashi Medical Center

Correspondence to: Hiroto Matsuse, Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, 2_17_6, Ohashi, Meguro-ku, Tokyo 153_8515 Japan.

(E-mail: hiroto.matsuse@med.toho-u.ac.jp) −−−−−−−−Case Report−−−−−−−−

A CASE OF PULMONARY MYCOBACTERIUM ABSCESSUS INFECTION

THAT DEVELOPED DURING IMMUNOSUPPRESSIVE THERAPY

FOR MYASTHENIA GRAVIS WITH RECURRENT THYMOMA

(7)

Miliary Tuberculosis Originated from Cutaneous Infection / K. Koda et al. 63

11) 倉澤卓也, 加藤元一, 鈴木克洋, 他:粟粒結核症の臨床 的検討. 日胸疾会誌. 1989 ; 27 : 454.

12) ARDS Defi nition Task Force, Ranieri VM, Rubenfeld GD, et al.: Acute respiratory distress syndrome: the Berlin Defi ni-tion. JAMA. 2012 ; 307 : 2526 2533.

13) Bone RC, Fisher CJ, Clemmer Jr.TP, et al.: Early methyl-prednisolone treatment for septic syndrome and the adult respiratory distress syndrome. Chest. 1987 ; 92 : 1032 1036. 14) Bernard GR, Luce JM, Sprung CL, et al. : High-dose

corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med. 1987 ; 317 : 1565 1570.

15) Tang BM, Craig JC, Eslick GD, et al.: Use of corticosteroids in acute lung injury and acute respiratory distress syndrome:

a systematic review and meta-analysis. Crit Care Med. 2009 ; 37 : 1594 1603.

16) Ruan SY, Lin HH, Huang CT, et al.: Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care. 2014 ;18 : R63. 17) 中島義仁, 福岡敏雄, 真弓俊彦, 他:ステロイドパルス 療法が有効であった粟粒結核によるARDSの 1 例. 日臨 救医誌. 1999 ; 2 : 438 442. 18) 原口京子, 坂下博之, 宮崎泰成, 他:急性呼吸窮迫症候 群(ARDS)を来たしステロイドが著効した粟粒結核の 1例. 日胸. 1999 ; 58 : 281 287.

Abstract An 86-year-old woman with severe dementia had been treated with oral prednisolone at 2 mg/day for autoim-mune bullous dermatosis for several years. One year ago, she referred to our hospital due to an ulcerative skin lesion over the right tibial tuberosity. The lesion was treated by an iodine-containing ointment, but did not heal. Subsequently, a new skin lesion appeared in the right popliteal fossa. One month ago, the patient had increased sputum production that was accompanied by fever, anorexia, and dyspnea ; consequently, she visited our department. Chest computed tomography revealed diffuse micronodules with ground-glass attenuation. Acid-fast bacteria staining of the sputum was positive and the polymerase chain reaction detected

Myco-bacterium tuberculosis. In addition, the bacilli were also found in the skin lesions of the right limb. Therefore, a diagnosis of cutaneous, and miliary tuberculosis was made. Although the anti-tuberculous combination chemotherapy consisting of isoniazid, rifampicin, and ethambutol was immediately initiated, her condition did not improve. She died on day19

of hospitalization. Drug susceptibility testing revealed no resistance to all the three drugs; hence, it was concluded that the time-delay in diagnosis of cutaneous tuberculosis lead to the progression to miliary tuberculosis and subsequent death. Key words: Cutaneous tuberculosis, Miliary tuberculosis, Acute respiratory distress syndrome

1Department of Respiratory Medicine, Respiratory Disease

Center, Seirei Mikatahara General Hospital, 2Second

Department of Internal Medicine, Hamamatsu University School of Medicine

Correspondence to : Keigo Koda, Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu-shi, Shizuoka 433_8558 Japan.

(E-mail: koudakeigokouda@yahoo.co.jp) −−−−−−−−Case Report−−−−−−−−

A CASE OF MILIARY TUBERCULOSIS ORIGINATED FROM CUTANEOUS INFECTION

1Keigo KODA, 1, 2Yasunori ENOMOTO, 1Minako OMAE, 1Daisuke AKAHORI, 1Takefumi ABE, 1Hirotsugu HASEGAWA, 1Takashi MATSUI, 1Koshi YOKOMURA,

(8)

結核 第 91 巻 第 2 号 2016 年 2 月 68 わしい症例への診断の一助として,PET-CT は有用な検 査になるのではないかと考えられた。  本論文の要旨は第 186 回日本呼吸器学会関東地方会で 発表した。

 著者の COI(confl icts of interest)開示:本論文発表内 容に関して特になし。

文   献

1 ) Wahidi MM, Govert JA, Goudar RK, et al.: Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? : ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 ; 132 : 94S 107S. 2 ) Larrieu AJ, Tyers GF, Williams EH, et al.: Recent

experi-ence with tuberculous pericarditis. Ann Thorac Surg. 1980 ; 29 : 464 468.

3 ) McCaughan BC, Schaff HV, Piehler JM, et al.: Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg. 1985 ; 89 : 340 350.

4 ) 椎名 明, 土屋正雄, 難波義治, 他:短期間に収縮性心 膜炎に移行した急性結核性心膜炎の2-Dエコー所見. 日 超医論文集. 1982 ; 41 : 161 162. 5 ) 有馬瑞浩, 羽鳥 慶, 松田 督, 他:結核性心膜炎から 収縮性心膜炎へ経過観察しえた 1 例. Therapeutic Re-search. 2005 ; 26 : 1641 1646. 6 ) 志賀 孝, 須甲陽二郎, 神田順二, 他:結核性心膜炎の 1例. 旭中央日報. 1994 ; 16 : 35 40.

7 ) Sagrista-Sauleda J, Permanyer-Miralda G, Soler-soler J : Tuberculous pericarditis: ten-year experience with a pro-spective protocol for diagnosis and treatment. J Am Coll Cardiol. 1988 ; 11 : 724 728.

8 ) Cegielski JP, Devin BH, Morris AJ, et al.: Comparison of PCR, culture, and histopathology for diagnosis of tuber-culous pericarditis. J Clin Microbiol. 1997 ; 35 : 3254 3257.

9 ) Strang G, Latouf S, Commerford P, et al.: Bedside culture to confi rm tuberculous pericarditis. Lancet. 1991 ; 338 : 1600 1601.

10) Zayas R, Anguita M, Torres F, et al.: Incidence of specifi c etiology and role of methods for specifi c etiologic diagnosis of primary acute pericarditis. Am J Cardiol. 1995 ; 75 : 378 382.

Abstract A 72-year-old man presented with fever, dyspnea, and weight loss. He was referred to our hospital for further examination of the cause of the pleural effusions. Chest computed tomography showed pleural effusions, a pericardial effusion, and enlarged lymph nodes in the carina tracheae. We administered treatment for heart failure and conducted analyses for a malignant tumor. The pericardial effusion im-proved, but the pericardium was thickened. Positron emission tomography_computed tomography (PET-CT) showed fl uo-rine-18 deoxyglucose accumulation at the superior fovea of the right clavicle, carina tracheae, superior mediastinum lymph nodes, and a thickened pericardium. Because these fi ndings did not suggest malignancy, we assumed this was a tuberculous lesion. Echocardiography confi rmed this fi nding as constrictive pericarditis; therefore, pericardiolysis was per-formed. Pathological examination showed features of caseous

necrosis and granulomatous changes. Hence, the patient was diagnosed with tuberculous constrictive pericarditis. PET-CT serves as a useful tool for the diagnosis of tuberculous pericarditis.

Key words: Tuberculous pericarditis, Constrictive pericar-ditis, FDG-PET

Division of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital

Correspondence to: Hiroki Takakura, Department of Respi-ratory Medicine, Saiseikai Yokohamashi Tobu Hospital, 3_ 6_1, Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa 230_0012 Japan. (E-mail: takakura@tobu.saiseikai.or.jp) −−−−−−−−Case Report−−−−−−−−

TUBERCULOUS CONSTRICTIVE PERICARDITIS DETECTED ON

POSITRON EMISSION TOMOGRAPHY

(9)

結核 第 91 巻 第 2 号 2016 年 2 月 74

Abstract Modern National Tuberculosis Program (NTP) of Japan started in 1951 when Tuberculosis (TB) Control Law was legislated, and 3 major components were health exami-nation by tuberculin skin test (TST) and miniature X-ray, BCG vaccination and extensive use of modern TB treatment. As to the treatment program, Japan introduced Public-Private Mix (PPM) from the very beginning, and major reasons why PPM was adopted are ①TB was then highly prevalent (Table 1), ②TB sanatoria where many specialists are working are located in remote inconvenient places due to stigma against TB, ③health centers (HCs) in Japan are working exclusively on prophylactic activities, and minor exceptions are treatment of sexually transmitted diseases and artifi cial pneumothorax for TB cases, however, as it covers on the average 100,000 population, access is not so easy in rural area, ④Out-patients clinics mainly operated by general practitioners (GPs) are located throughout Japan, and the access is easy.

 Methods of TB treatment was developing rapidly in early 1950s, however, in 1952, as shown in Table 2, artifi cial pneumothorax and peritoneum were still used in many cases, and to fi x the dosage of refi ll air, fl uoroscopy was needed. Hence, GPs treating TB under TB Control Law had to be equipped with X-ray apparatus.

 To maintain the quality of TB treatment, Criteria for TB treatment was provided and revised taking into consideration the progress in TB treatment. If applied methods of treatment fi t with the above criteria, public support is made for the cost of TB treatment. To discuss the applied treatment, TB Advisory

Committee was set in each HC, composing of 5 members, director of HC, 2 TB specialists and 2 doctors recommended by the local medical association.

 In 1953, the fi rst TB prevalence survey using stratifi ed random sampling method was carried out, and the prevalence of TB requiring treatment was estimated at 3.4%, and only 21% of found cases knew their own disease, and more than half of all TB were found above 30 years of age. Based on these results, mass screening was expanded to cover whole population in 1955, and since 1957, cost of mass screening and BCG vaccination was covered 100% by public fund.  Unifi ed TB registration system covering whole Japan was introduced in 1961, and in the same year, national government subsidy for the hospitalization of infectious TB cases was raised from 50% to 80%.

 Hence, Japan succeeded to organize PPM system in TB care, and with 10% annual decline of TB, in 1975, Japan moved into the TB middle prevalence country.

Key words : TB Control Law, PPM (Public-Private Mix), Medical institutions designated to treat TB cases under TB Control Law, Artifi cial pneumothorax

Japan Anti-Tuberculosis Association

Correspondence to : Tadao Shimao, Japan Anti-Tuberculosis Association, 1_3_12, Misaki-cho, Chiyoda-ku, Tokyo 101_ 0061 Japan. (E-mail: tshimao@jatahq.org)

−−−−−−−−Review Article−−−−−−−−

PECULIARITY OF NATIONAL TUBERCULOSIS PROGRAM, JAPAN

― Public-Private Mix from the Very Beginning, and Provision of X-ray Apparatus

in Most General Practitioner’s Clinics ― Tadao SHIMAO

(10)

結核 第 91 巻 第 2 号 2016 年 2 月 82

mycobacteria-infected macrophages depends on autocrine-paracrine cytokine signaling. Sci Signal. 2010 ; 3 (135) : ra62. doi: 10.1126/scisignal.2000955.

33) Liao X, Sharma N, Kapadia F, et al.: Krüppel-like factor 4 regulates macrophage polarization. J Clin Invest. 2011 ; 121 : 2736 2749.

34) Guler R, Parihar SP, Savvi S, et al.: IL-4Rαα-dependent alternative activation of macrophages is not decisive for Mycobacterium tuberculosis pathology and bacterial burden in mice. PLoS One. 2015 ; 10 : e0121070. doi : 10.1371/ journal. pone. 0121070.

35) Tomioka H: Suppressor macrophages induced by

myco-bacterial infections. In: Current Topics on the Profi les of Host Immunological Response to Mycobacterial Infections, Tomioka H, ed., Research Signpost, Kerala, 2009, 251 280. 36) Tatano Y, Shimizu T, Tomioka H: Unique macrophages

different from M1/M2 macrophages inhibit T cell mitogenesis while upregulating Th17 polarization. Sci Rep. 2014 ; 4 : 4146. doi: 10. 1038/srep04146.

37) François M, Romieu-Mourez R, Li M, et al.: Human MSC suppression correlates with cytokine induction of indole-amine 2, 3-dioxygenase and bystander M2 macrophage differentiation. Mol Ther. 2012 ; 20 : 187 195.

Abstract In the advanced stages of mycobacterial infec-tions, host immune systems tend to change from a Th1-type to Th2-type immune response, resulting in the abrogation of Th1 cell- and macrophage-mediated antimicrobial host pro-tective immunity. Notably, this type of immune conversion is occasionally associated with the generation of certain types of suppressor macrophage populations. During the course of infections due to pathogenic mycobacteria, the generation of macrophages which possess strong suppressor activity against host T- and B-cell functions is frequently encountered. This review describes the immunological properties of M1- and M2-type macrophages generated in hosts with certain micro-bial infections including mycobacteriosis and those generated in tumor-bearing animals. Particularly, this paper highlights the immunological and molecular biological characteristics of M1 and M2 macrophage populations, which are induced by

mycobacterial infections.

Key words : M1 macrophage, M2 macrophage, Immunosup-pressive macrophage, Th17 cell, Mycobacterial infection

1Department of Basic Medical Science for Nursing, Yasuda

Women’s University, 2Department of Microbiology and

Immu-nology, Shimane University School of Medicine, 3Department

of Pharmaceutical Sciences, International University of Health and Welfare, 4Department of Nutrition Administration, Yasuda

Women’s University

Correspondence to: Haruaki Tomioka, Department of Basic Medical Science for Nursing, Yasuda Women’s University, 6_13_1, Yasuhigashi, Asa-minami-ku, Hiroshima-shi, Hiro-shima 731_0153 Japan. (E-mail: tomioka@yasuda-u.ac.jp) −−−−−−−−Review Article−−−−−−−−

M1 AND M2 MACROPHAGE POPULATIONS:

THOSE INDUCED AND ACTIVATED BY MYCOBACTERIAL INFECTIONS

(11)

90 結核 第 91 巻 第 2 号 2016 年 2 月

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

TUBERCULOSIS ANNUAL REPORT 2014

─ (1) Summary of Statistics on Tuberculosis Notifi cation and Foreign-born Tuberculosis Patients ─

Tuberculosis Surveillance Center (TSC), RIT, JATA Abstract This brief is the fi rst of a series of documents

based on the Tuberculosis Annual Report 2014. It includes a summary of tuberculosis (TB) statistics, including data on foreign-born TB patients notifi ed and registered in Japan in 2014.

 For the fi rst time, the number of newly notifi ed cases (all forms of TB) fell below 20,000. In 2014, a total of 19,615 patients were notifi ed, a rate of 15.4 per 100,000 population. The number of sputum-smear positive pulmonary TB patients notifi ed was 7,651, a rate of 6.0 per 100,000 population.  The number of patients with latent TB infections increased slightly from 7,147 in 2013 to 7,562 in 2014. The proportion of miliary TB cases has constantly increased over the past 10 years, especially among women aged 80 years and older.  The number of foreign-born TB patients continued to in-crease from 1,064 in 2013 to 1,101 in 2014. In 2014, new foreign-born TB patients aged 20_29 years accounted for 44.1 % of all new TB patients in that age group. Among foreign-born TB patients, half were from the Philippines (26.5%) and China (23.5%). However, the number of patients from Vietnam

and Nepal is increasing. Among foreign-born TB patients, 28% were regular employees, 26% were students, and 20% were unemployed. The changing trend in the nationality of foreign students entering Japan may at least partially ex-plain the differences in TB burden among foreign-born pa-tients, by country of birth. As we expect to see the proportion of foreign-born TB patients continue to rise, more tailored case identifi cation and treatment support activities are needed. Key words: Tuberculosis, Notifi cation rate, Latent tubercu-losis infection, Country of origin, Occupation

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

Correspondence to: Lisa Kawatsu and Kazuhiro Uchimura, Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), JATA, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan.

(E-mail: tbsur@jata.or.jp) 03/dl/zenbun.pdf(2013 年 11 月 7 日閲覧)

2 ) 結核研究所疫学情報センター:結核年報 2011(1)結核 発生動向速報・外国人結核. 結核. 2013 ; 88 : 571 576. 3 ) Gomes T, Vinhas SA, Reis-Santos B, et al. : Extrapulmonary

tuberculosis : Mycobacterium tuberculosis strains and host risk factors in a large urban setting in Brazil. PLoS One. 2013 ; 2 ; 8 (10) : e74517.

4 ) Sharma SK, Mohan A, Sharma A, et al. : Miliary tubercu-losis : new insights into an old disease. Lancet. 2005 ; 5 (7) : 415 430.

5 ) 財団法人日本語教育振興協会:外国人留学生在籍状況 調査結果. 平成 26 年. http://www.nisshinkyo.org/news/B-26-1.html(2015 年 7 月 24 日閲覧)

Updating...

参照

Updating...

関連した話題 :