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(1)

Relapse after Standard TB Treatment / Internal Medicine Group of Ryoken 415

Abstract [Background] Risk of relapse after standard

treat-ment of tuberculosis has not been evaluated recently in Japan.  [Objective] To investigate the risk of relapse after standard treatment of tuberculosis and its timing.

 [Method] Multi institutional prospective cohort study of standard treatment cases of tuberculosis. Cases that completed the treatment are included in the analysis.

 [Results] Among 284 cases evaluated, 127 cases prolonged treatment more than 6 months. Five cases relapsed including 4 culture positive relapse cases within 2 years, no relapse at 3rd and 4th year and 2 cases relapsed later. 2.1% of all cases relapsed by life table analysis until 2nd year and 4th year. Relapse was more observed among service industry workers. All relapse cases were smear and culture negative 2 weeks

after starting treatment. Many cases with risk factors of re-lapse, such as diabetes mellitus cases and immunocompro-mised persons were treated longer than 6 months and these factors did not contribute for the relapse.

 [Conclusion] No relapse was observed at 3rd and 4th year and follow up at 3rd and 4th year was not considered as necessary.

Key words: Tuberculosis, Standard treatment, Relapse

Correspondence to: Takashi Yoshiyama, Research Insti-tute of Tuberculosis, Japan Anti-Tuberculosis Association, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan. (E-mail: yoshiyama@jata.or.jp)

−−−−−−−−Original Article−−−−−−−−

RELAPSE AFTER STANDARD TREATMENT OF TUBERCULOSIS

Internal Medicine Group of Ryoken

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結核 第 93 巻 第 6 号 2018 年 6 月 420

Abstract [Object] Evaluation of blood sample stability

stored at 4 C for 32 hours after blood drawing for Quati-FERON TB Gold (QFT-3G).

 [Materials and Methods] Blood samples from 27 donors were drawn into multiple lithium heparin (LiHep) tubes. The blood samples from one LiHep tubes were aliquoted into QFT-3G tubes at room temperature (Control group) and the other LiHep tubes were stored at 4 C for 32 hours and then aliquoted into QFT-3G tubes (Study group). The QFT-3G test results using blood samples of the Study group were compared to those of the Control group.

 [Results] Interferon-γγ levels of the Study group (y) significantly correlated with those of the Control group (x) :

y=0.979 x−0.166 (n=27, r=0.982, p<0.01). The total agreement between these two groups was 88.9% (24/27), with a positive agreement of 88.2% (15/17), and negative agreement of 90.0% (9/10). Discrepant interpretations were found in three instances, of which interferon-γγ levels were in

the vicinity of the cut-off point and within the expected limit of assay variation. The results of the Bland-Altman analysis did not show significant differences between these two groups.  [Conclusion] The results support single LiHep blood draw and storage at 4 C for 32 hours prior to blood transfer to the QFT-3G assay tubes as there was no significant loss of reactivity found compared to standard methods.

Key words : Tuberculosis, QuantiFERON, Temperature,

Blood sample stability

Department of Respiratory, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital

Correspondence to: Kiyoyasu Fukushima, Department of Respiratory, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, 986_2, Keya, Tarami-cho, Isahaya-shi, Nagasaki 859_0497 Japan. (E-mail: kiyofuku@isahaya.jrc.or.jp) −−−−−−−−Short Report−−−−−−−−

STUDY ON TIME-RELATED STABILITY OF BLOOD SAMPLE FOR

QuantiFERON

®

TB GOLD AS AN IN VITRO DIAGNOSTIC FOR

INFECTION WITH MYCOBACTERIUM TUBERCULOSIS

Kiyoyasu FUKUSHIMA, Toru KUBO, Yuko KANEKO, Naomi EHARA,

and Toyoshi MATSUTAKE Tube assays. Journal of infection. 2015 ; 71 : 276_280.

5 ) Wang-Yang M, Buttke TM, Miller NW, et al.: Temperature-mediated processes in immunity: Differential effects of low

temperature on mouse T helper cell responses. Cellular Immunology. 1990 ; 126 : 354_366.

(3)

結核 第 93 巻 第 6 号 2018 年 6 月 426

Abstract The patient was a 68-year-old man who was

admitted to our hospital because he developed a fever associated with ascites and diarrhea. 7 months after the beginning of adalimumab treatment for rheumatoid arthritis that was uncontrollable by using steroids and methotrexate. An abdominal CT scan revealed an increase of ascites and mesenteric fat tissue concentration. The examination of ascites showed elevated ADA at 164.7 IU/l. A defi nitive diagnosis of peritoneal tuberculosis was made through identi-fi cation of Mycobacterium tuberculosis in culture of ascites and epithelioid cell granuloma in laparoscopic peritoneal biopsy. Peritoneal tuberculosis resolved along with the discontinuation of adalimumab and initiation of tuberculosis treatment. However, joint symptoms began to worsen gradually. When it became uncontrollable despite the gradual increase of steroids and methotrexate, abatacept was re-administered in place of biological agents after the

comple-tion of tuberculosis treatment. Since then, the patient had an uneventful course without any relapse or exacerbation of both tuberculosis and rheumatoid arthritis. We report this case in which we confi rmed an effi cacy and safety of re-administra-tion of biological agent.

Key words : Biological agent, Adalimumab, Rheumatoid

arthritis, Tuberculous peritonitis, Re-administration

Department of Respiratory Medicine, Saitama Red Cross Hospital

Correspondence to: Shintaro Sato, Department of Respiratory Medicine, Saitama Red Cross Hospital, 1_5, Shintoshin, Chuo-ku, Saitama-shi, Saitama 330_8553 Japan.

(E-mail: smallerss@hotmail.com) −−−−−−−−Case Report−−−−−−−−

A CASE OF RHEUMATOID ARTHRITIS COMPLICATED WITH

TUBERCULOUS PERITONITIS DURING TREATMENT WITH ADALIMUMAB

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Refractory MAC Pneumothorax / Y. Uchida et al. 431

Abstract A 67-year-old man with rheumatoid lung was

admitted to our hospital because of fever, dyspnea and chest pain. Right-sided pneumothorax was recognized on a chest radiograph, and chest tube drainage was performed. A result of smear of the pleural fl uid was positive. Mycobacterium

intracellulare was identifi ed by PCR method from the organisms of sputum and pleural fl uid specimens. Pneumo-thorax and pleuritis were improved with percutaneous tube drainage and anti-nontuberculous mycobacteriosis (NTM) chemotherapy. But right-sided lung pneumothorax was not cured completely. A portable pneumothorax drainage kit during an outpatient stay and continued chemotherapy were effective for keeping his general condition. Endobronchial Watanabe spigots (EWS) procedure was failed to treat the pneumothorax in this case. Finally, surgical therapy was

performed, and pneumothorax was improved. A portable pneumothorax drainage kit during outpatient stay for six months was useful for keeping general condition.

Key words : Pulmonary nontuberculous mycobacteriosis,

Pneumothorax, Portable pneumothorax drainage kit, Rheu-matoid arthritis, Interstitial pneumonia

Department of Respiratory Medicine, Yamanashi Prefectural Central Hospital

Correspondence to: Yoshinori Uchida, Department of Respi-ratory Medicine, Yamanashi Prefectural Central Hospital, 1_1_1, Fujimi, Kofu-shi, Yamanashi 400_8506 Japan. (E-mail: uchida-bfvw@ych.pref.yamanashi.jp) −−−−−−−−Case Report−−−−−−−−

A CASE OF REFRACTORY PNEUMOTHORAX ASSOCIATED WITH

MYCOBACTERIUM INTRACELLULARE

WHICH WAS CURED BY SURGERY

AFTER LONG-TERM DRAINAGE AND ANTIBIOTICS THERAPY

Yoshinori UCHIDA, Yumiko KAKIZAKI, and Yoshihiro MIYASHITA キュレットを使用した EWS 充填の有用性について. 気 管支学. 2012 ; 34 : 442 449. 5 ) 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. 6 ) 中村治彦, 神尾重則, 山田哲司, 他:自然気胸の治療 成績―特にハイムリッヒ弁使用による外来治療につい て. 日胸疾会誌. 1986 ; 24 : 1253 1257. 7 ) 江花弘基, 栗原正利, 片岡秀之, 他:Thoracic Egg® 用いた自然気胸に対する外来ドレナージ療法の評価. 日救急医会誌. 2011 ; 22 : 803 809. 8 ) 竹下伸二, 村松 高, 四万村三恵, 他:自然気胸に対 するソラシックエッグ®挿入症例の検討. 日呼外会誌. 2011 ; 25 : 363 366.

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