February

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Abstract [Objective] We reported the results of our

eval-uation for rapid diagnosis of tuberculosis of TB-LAMP with samples other than sputum.

 [Results] The study was conducted between August 2014 and March 2018. Of 56 samples from gastric aspiration, BAL, pleura, lung, pleura effusion, abdominal dropsy, pus and ear discharge were 29, 10, 3, 2, 6, 2, 3 and 1 samples, MGIT culture positive samples, 47 (83.9%) were judged to be pos-itive by the TB-LAMP assay, with a mean pospos-itive detection time of 18 minutes 55 seconds. Of 44 smear-negative samples and MGIT positive samples, 35 (79.5%) were judged to be positive by the TB-LAMP assay, with a mean positive detection time of 19 minutes 41 seconds. The mean positive detection time of 8 samples (gastric aspiration 1 sample, pleura effusion 2 samples, pus 4 samples, tissue 1 sample) with MGIT culture negative and TB-LAMP positive was 17 minutes 05 seconds, from retreatment patients who were active tuberculosis.

 [Conclusion] TB-LAMP assay is considered effective tuber-culosis diagnosis with samples other than sputum detected positive MGIT negative samples from retreatment patients.

Key words : Gastric aspiration, BAL, Pleura effusion,

Molecular-based diagnostic test, TB-LAMP, MGIT positive samples, NALC-treatment sample

1Department of Laboratory, 2Department of Infection Diseases, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center

Correspondence to: Hiroko Yoshida, Department of Labo-ratory, Osaka Prefectural Hospital Organization Osaka Habiki-no Medical Center, 3_7_1, HabikiHabiki-no, HabikiHabiki-no-shi, Osaka 583_8588 Japan. (E-mail: yoshidahi@opho.jp)

−−−−−−−−Original Article−−−−−−−−

STUDY OF TB-LAMP WITH GASTRIC ASPIRATION, BAL,

PLEURA EFFUSION AND OTHER SAMPLES ABOUT EFFICIENCY

FOR RAPID DIAGNOSIS OF TUBERCULOSIS

1Hiroko YOSHIDA, 1Kenichi ONOHARA, 1Chika MATSUI, 2Hiromune TAKADA, 2Tsuyoshi ARAI, 2Yuki TSURINAGA, 2Yuki HAN, 2Shoji HASHIMOTO,

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結核 第 94 巻 第 2 号 2019 年 2 月 26

Abstract [Purpose] To examine the detection of secondary

cases (ie. contacts who have developed tuberculosis disease as a result of transmission from the index case) in contact investigation and treatment outcomes of latent tuberculosis infection (LTBI).

 [Methods] Of contacts in whom QFT-3G (QFT) was performed in contact investigation by the Osaka City Public Health Offi ce between 2011 and 2015, the subjects were QFT-positive persons. In these subjects, we examined the necessity of LTBI treatment. In those who underwent LTBI treatment, we investigated treatment outcomes and presence or absence of onset. Furthermore, the detection of secondary cases was examined.

 [Results] 1) QFT was conducted in 6,486 contacts. Of these, 871 (13.4%) showed positive reactions.

 2) Of 871 contacts in whom the necessity of LTBI treat-ment was examined due to QFT-positive reactions, it was necessary in 697. Concerning the treatment outcomes of LTBI, it was completed in 480 contacts, it was defaulted in 73, it was untreated in 81, and other circumstances were present in 63. Onset within 2 years was noted in 0.8% of the completed contacts, in 2.7% of the treatment-defaulted contacts, and in 8.6% of the untreated contacts. There were signifi cant differences in the treatment outcomes and incidence (p<0.01). LTBI treatment was unnecessary despite QFT-positive reactions in 174 contacts. As the reasons, the onset of tuberculosis was clarifi ed around the

same time as QFT-positive reactions became clear in 70 contacts, a diagnosis of tuberculosis had been previously infected in 13, and other reasons were present in 91.  3) Of 871 QFT-positive contacts, there were 84 secondary cases (9.6%). When comparing the secondary cases with onset-free, QFT-positive contacts, the rate of contacts with a cough period of ≧3 months for index cases and that of those with a cavity in X-ray fi ndings were signifi cantly higher in the former (p<0.05).

 [Conclusion] Most secondary cases were detected around the same time as QFT-positive reactions became clear. The timing of LTBI treatment was overlooked, but the incidence was signifi cantly lower in the LTBI-treatment-completed contacts. Therefore, the widespread use of a QFT and educa-tion may be important for early deteceduca-tion.

Key words : Tuberculosis, Contact investigation, Secondary

case, LTBI, Treatment outcome, QFT

1Osaka City Public Health Offi ce, 2Nishinari Ward Offi ce, Osaka City, 3Osaka Institute of Public Health

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) −−−−−−−−Original Article−−−−−−−−

DETECTION OF SECONDARY CASES IN CONTACT INVESTIGATION

AND TREATMENT OUTCOMES OF LATENT TUBERCULOSIS INFECTION

1, 2Kenji MATSUMOTO, 1Jun KOMUKAI, 1Yuko TSUDA, 1Hideya UEDA, 1Rie AOKI, 1Miho TAKEGAWA, 1Yumi IKEDA, 3Kaori YAMAMOTO,

(3)

Abstract [Background] Limited information is currently

available on the outcomes of bilateral surgical treatments for nontuberculous mycobacterial lung disease (NTM-LD) with destructive lesions on both sides.

 [Objective] To show the outcomes of bilateral surgical treatments for drug-resistant NTM-LD with destructive le-sions on both sides.

 [Methods] Eleven patients underwent two (bilateral, staged) procedures for NTM-LD between January 2008 and June 2018. Age, bacterial species, disease type, chemotherapy, surgical procedure, recurrence, pulmonary functions, etc. were evaluated retrospectively.

 [Results] The median age is 58 years and all were female. The etiological species were M.avium in 10 patients and M.intracellulare in one. All patients were nodular bronchiectatic type. Resections of the right middle lobe and the left lingular segment were performed by two staged surgeries in all patients and partial resection of the upper lobe was added in three. No complications due to surgeries were observed. All patients achieved sputum culture conversion after second surgery, however, six (55%) developed recur-rence during the follow-up period.

 [Conclusions] Two staged bilateral surgeries for drug-resistant NTM-LD have acceptable outcomes. Better control of the disease may be achieved in some patients with destruc-tive lesions on both sides through two staged bilateral surgical treatments.

Key words : Nontuberculous mycobacterial lung disease

(NTM-LD), Drug resistance, Bilateral lesions, Surgical treatment, Staged surgery

1Department of Thoracic Surgery, 2Department of Pulmonary Medicine, National Hospital Organization Higashinagoya National Hospital; 3Department of Thoracic Surgery, National Hospital Organization Nagoya Medical Center; 4Department of Quality and Safety in Healthcare, Fujita Health University Hospital

Correspondence to: Katsuo Yamada, Department of Thoracic Surgery, National Hospital Organization Higashinagoya Na-tional Hospital, 5_101, Umemorizaka, Meito-ku, Nagoya-shi, Aichi 465_8620 Japan. (E-mail: k123yamada@gmail.com) −−−−−−−−Original Article−−−−−−−−

TREATMENT OUTCOMES OF BILATERAL SURGERIES

FOR NONTUBERCULOUS MYCOBACTERIAL LUNG DISEASE

WITH DESTRUCTIVE LESIONS ON BOTH SIDES

1Katsuo YAMADA, 4Ayuko YASUDA, 3Yukio SEKI, 2Yasuhiro FUKUI, 2Mitsuaki YAGI, 2Osamu TARUMI, 2Yuta HAYASHI, 2Taku NAKAGAWA,

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結核 第 94 巻 第 2 号 2019 年 2 月 38

Abstract [Objective] To compare the drug susceptibility

testing (DST) results of kanamycin (KM) and amikacin (AMK) between Ogawa and Löwenstein-Jensen (L-J) media.  [Method] Ogawa media containing 20 and 30 µg/ml of KM (Ogawa KM20 and KM30), and 30 µg/ml of AMK (Ogawa AMK30) were prepared, respectively. Similarly, L-J media containing 30 µg/ml of KM (L-J KM30) and 30 µg/ml of AMK (L-J AMK30) were also prepared. A total of 114 clinical Mycobacterium tuberculosis (MTB) isolates including 92 multidrug-resistant ones were tested with each medium, and the results were compared. McNemar test was used for the analyses.

 [Result] The McNemar test showed signifi cant difference of DST results between L-J KM30 vs. Ogawa KM20 (p= 0.0133), but not between L-J KM30 vs. Ogawa KM30 (p=0.134). DST of AMK showed 100% concordance between Ogawa and L-J medium.

 [Discussion] Ogawa proportion method with 30 µg/ml of KM was almost equivalent to that of L-J method, while Ogawa KM20 detected less resistances. As to AMK, Ogawa method could yield same DST results with L-J method. The

modifi cation of current KM concentration from 20 to 30 µg/ ml could make the Ogawa proportion method universally acceptable. It was also evident that Ogawa medium could be used for proportion method of AMK. Those concentration settings of KM and AMK in 1% Ogawa medium will be important to standardize the DST results compared to other countries.

Key words : Mycobacterium tuberculosis, Antimicrobial

sus-ceptibility testing, Kanamycin, Amikacin

1Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 2Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences

Correspondence to: Akio Aono, Department of Myco-bacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan.

(E-mail: aono@jata.or.jp) −−−−−−−−Short Report−−−−−−−−

EVALUATION OF KANAMYCIN AND AMIKACIN SUSCEPTIBILITY TESTING

ON OGAWA MEDIA AGAINST MYCOBACTERIUM TUBERCULOSIS

1Akio AONO, 1Kinuyo CHIKAMATSU, 1Yuriko IGARASHI, 1Yoshiro MURASE, 1Hiroyuki YAMADA, 1Akiko TAKAKI, and 1, 2Satoshi MITARAI

文   献 1 ) 結核予防会編:「結核の統計2017」, 結核予防会, 東京, 2017. 2 ) 日本結核病学会治療委員会:「結核医療の基準」の改 訂―2018年. 結核. 2018 ; 93 : 61 68. 3 ) 結核病学会薬剤耐性検査検討委員会:結核の薬剤感受 性試験, 特に試験濃度改変と比率法導入の提案. 結核. 1997 ; 72 : 597 598.

4 ) Canetti G, Fox W, Khomenko A, et al.: Advances in tech-niques of testing mycobacterial drug sensitivity and the use of sensitivity tests in tuberculosis control programmes. Bull WHO. 1969 ; 41 : 21 43.

5 ) World Health Organization: WHO Technical Report on critical concentrations for drug susceptibility testing of medicines used in the treatment of drug-resistant tubercu-losis. WHO reference number: WHO/CDS/TB/2018.5. http:// www.who.int/tb/publications/2018/WHO_technical_report_

concentrations_TB_drug_susceptibility/en/

6 ) 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」, 南江堂, 東京, 2016.

7 ) Ajbani K, Lin SY, Rodrigues C, et al.: Evaluation of pyrosequencing for detecting extensively drug-resistant Mycobacterium tuberculosis among clinical isolates from four high-burden countries. Antimicrob Agents Chemother. 2015 ; 59 : 414 20.

8 ) Rodwell TC, Valafar F, Douglas J, et al.: Predicting extensively drug-resistant Mycobacterium tuberculosis phe-notypes with genetic mutations. J Clin Microbiol. 2014 ; 52 : 781 789.

9 ) Chan ED, Stand MJ, Iseman MD: Multidrug-resistant tuberculosis (TB) resistant to fl uoroquinolones and strep-tomycin but susceptible to second-line injection therapy has a better prognosis than extensively drug-resistant TB. Clin Infect Dis. 2009 ; 48 : e50-2.

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Abstract A previous healthy 24-year-old man came to

our hospital. Chest image revealed nodule and infi ltrative shadows with cavity in the upper lobe of the right lung. In the sputum, the acid-fast bacterial smear and Mycobacterium

tuberculosis PCR were negative. In addition, it was not possible to detect bacteria even in smear and culture of general bacteria and acid-fast bacteria of bronchial lavage fl uid. In the second bronchoscopy, bronchoalveolar lavage was performed, and the obtained fl uid was anaerobically cultured which was not performed previously, and as a result, actinomycetes was detected. At a later date, the obtained bacteria were identi-fi ed as Actinomyces odontolyticus in the genus Streptomyces. SBT/ABPC was administered for 14 days, shading was im-proved, after that, it was changed to oral administration of AMPC, and treatment continued. It is known that pulmonary actinomycosis occurs also in people without basic disease. In this example, diagnosis could be reached by performing anaerobic culture of bronchoalveolar lavage fl uid. We reported

a case of rare A.odontolyticus lung disease.

Key words : Anaerobic culture, Actinomyces odontolyticus,

Juvenile, Lung abscess, Pulmonary actinomycosis

1Department of Respiratory Medicine, The Center of Chest Diseases and Severe Motor & Intellectual Disabilities, National Hospital Organization Ibarakihigashi National Hospital; 2Department of Respiratory Medicine, Graduate School of Medicine, University of Tsukuba

Correspondence to: Kentaro Hyodo, Department of Respira-tory Medicine, The Center of Chest Diseases and Severe Motor & Intellectual Disabilities, National Hospital Orga-nization Ibarakihigashi National Hospital, 825, Terunuma, Tokai-mura, Naka-gun, Ibaraki 319_1113 Japan.

(E-mail: iwtbagdr@gmail.com) −−−−−−−−Case Report−−−−−−−−

A CASE OF PULMONARY SUPPURATIVE DISEASE CAUSED BY

ACTINOMYCES ODONTOLYTICUS WHICH OCCURRED IN YOUNG MAN

WITHOUT BASIC DISEASE AND REQUIRED TO DIFFERENTIATE

FROM PULMONARY TUBERCULOSIS

1Kentaro HYODO, 1, 2Jun KANAZAWA, 1Sousuke MATSUMURA, 1Takafumi SHIMADA, 1Yuka KITAOKA, 1Hitomi GOTO, 1Yuika SASATANI, 1, 2Masayuki NAKAJIMA,

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結核 第 94 巻 第 2 号 2019 年 2 月 50

Abstract A 56-year-old man was admitted to previous

hos-pital because of cough and fever. CT scan revealed pleural effusion on the left side, diffuse thickening of the peritoneum, and swelling of the abdominal lymph nodes. Although the ADA level in the pleural effusion was high, other laboratory fi ndings showed no evidence of tuberculous infection. He was suspected of having carcinomatous peritonitis because of the high accumulation of FDG in the overall peritoneal cavity on PET-CT. Finally, a surgical peritoneal biopsy showed a granuloma with caseous necrosis, and the result of the TB-PCR was positive in the specimen. Accordingly, he was diag-nosed with tuberculous peritonitis. He was transferred to our TB ward for treatment. The sputum smear (acid fast bacillus) and TB-PCR performed on admission yielded positive re-sults. Five days after the initiation of the anti-TB treatment, he developed adhesive intestinal obstruction. Owing to the conservative treatment, the symptoms receded and he

dis-charged from the hospital on the 104th day after admission. In this case, the diagnosis was delayed because of the lack of conclusive evidence of TB infection.

Key words : Pulmonary tuberculosis, 18F-fl uorodeoxyglucose positron emission tomography_computed tomography (FDG PET-CT), Biopsy of peritoneum

1Division of Infectious Diseases, Nagano Prefectural Shinshu Medical Center; 21st Department of Internal Medicine, Shinshu University School of Medicine

Correspondence to: Taisuke Araki, Division of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, 1332 Suzaka, Suzaka-shi, Nagano 382_0091 Japan.

(E-mail: araki-taisuke@pref-nagano-hosp.jp) −−−−−−−−Case Report−−−−−−−−

A CASE OF TUBERCULOUS PULMONARY TUBERCULOSIS AND PERITONITIS

AFTER A DELAYED DIAGNOSIS HAD BEEN GIVEN

BY SURGICAL PERITONEAL BIOPSY

1Taisuke ARAKI, 1Naoya IWANAMI, 1Mineyuki HAMA, 2Atsuhito USHIKI and 1Yoshitaka YAMAZAKI

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19) Lessnau KD, Milanese S, Talavera W, et al.: Mycobacte-rium gordonae: a treatable disease in HIV-positive patients.

Chest. 1993 ; 104 (6) : 1779 1785. 20) 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 (12) : 885 889. 21) 佐伯幸子, 松瀬厚人, 下田照文, 他:胸水貯留をきたし た肺 Mycobacterium gordonae 感染症の1例. 日呼吸会誌. 2004 ; 42 (1) : 103 107.

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