Characteristics of pleural effusion due to paradoxical response in patients with pulmonary tuberculosis.

BACKGROUND: Patients with pulmonary tuberculosis may present with deterioration of pleural effusion during anti-tuberculosis therapy, referred to as a paradoxical response (PR), with some patients requiring additional intervention. However, PR may be confused with other differential diagnoses, and the predictive factors for recommending additional therapies are unknown. Therefore, this study aimed to reveal useful information for the diagnosis and intervention of PR. METHODS: Data from human immunodeficiency virus-negative patients with tuberculous pleurisy (n = 210), including 184 patients with pre-existing pleural effusion and 26 patients with PR at Fukujuji Hospital, were retrospectively collected from January 2012 to December 2022 and compared. Furthermore, patients with PR were divided into the intervention group (n = 9) and the no intervention group (n = 17) and were compared. RESULTS: Patients in the PR group had lower pleural lactate dehydrogenase (LDH) (median 177 IU/L vs. 383 IU/L, p < 0.001) and higher pleural glucose (median 122 mg/dL vs. 93 mg/dL, p < 0.001) levels than those in the preexisting pleural effusion group. Other pleural fluid data were not significantly different. Patients in the intervention group had a shorter duration from the initiation of anti-tuberculosis therapy to the development of PR than patients in the no intervention group (median 19.0 days [interquartile range (IQR): 18.0-22.0] vs. median 37.0 days [IQR: 28.0-58.0], p = 0.012). CONCLUSION: This study demonstrates that, apart from lower pleural LDH and elevated pleural glucose levels, PR presents with similar features to preexisting pleural effusion and that patients who develop PR faster tend to require intervention.

Usefulness of gastric aspirate for the diagnosis of smear-negative pulmonary tuberculosis.

INTRODUCTION: Gastric aspirate can be useful for the diagnosis of pulmonary tuberculosis (TB) in patients with smear-negative pulmonary TB or without sputum production. The gastric aspirate smear technique has low sensitivity, and a previous report demonstrated that no patient was diagnosed by only gastric aspirate analysis. However, some patients with TB have been negative on sputum examination but positive on gastric aspirate examination, and the incidence of such cases is uncertain. Therefore, this study investigated the usefulness of gastric aspirate in the diagnosis of pulmonary TB. METHODS: To analyze the diagnostic accuracy of gastric aspirate examination, the data of 513 patients with negative sputum smears or a lack of sputum production, including 203 patients with pulmonary TB (39.6%) and 93 patients with nontuberculous mycobacteriosis who underwent gastric aspiration at Fukujuji Hospital from January 2016 to March 2021, were collected retrospectively. RESULTS: The accuracy rates of gastric aspirate examination for the diagnosis of pulmonary TB were as follows: 21.2% sensitivity and 91.9% specificity for smear positivity, 55.8% sensitivity and 99.6% specificity for nucleic acid amplification test positivity, and 71.4% sensitivity and 100% specificity for culture positivity. Twenty-three patients (11.2%) were diagnosed by gastric aspirate examination alone. Among the 356 patients who underwent three repeated sputum examinations in addition to gastric aspirate examination, the cumulative diagnostic rate for the 3 mycobacterial examinations plus gastric aspirate examination was higher than that for only three sputum examinations. CONCLUSIONS: Gastric aspirate is useful for the diagnosis of TB in patients with smear-negative pulmonary TB or without sputum production.

Multidrug Resistant Tuberculosis With Simultaneously Acquired Drug Resistance to Bedaquiline and Delamanid.

This study is the first to report a clinical case of simultaneously acquired resistance to bedaquiline (BDQ) and delamanid (DLM). Whole genome sequencing revealed 2 nucleotide insertions (Rv0678 and fbiC) in the Mycobacterium tuberculosis isolate. The minimum inhibitory concentrations for BDQ and DLM were 0.25 µg/mL and >2.0 µg/mL, respectively.

Analysis of risk factors for the development of a post-bronchoscopy respiratory infection in lung cancer patients.

BACKGROUND: The development of pneumonia following bronchoscopy is a very important post-bronchoscopic complication, while lung abscesses after bronchoscopy are rare. However, bronchoscopic techniques have advanced, and recently, we have observed patients with lung abscess after bronchoscopy. Therefore, the risk factors might vary from those in past reports. This study was performed to identify the incidence of and risk factors for post-bronchoscopy respiratory infections. METHODS: We retrospectively studied adult patients diagnosed with lung cancer by bronchoscopy at Fukujuji Hospital from January 2017 to June 2019. The infection and noninfection groups were compared. The incidence of lung abscess was compared between recent periods and 2013, when endobronchial ultrasonography with a guide sheath (EBUS-GS) was not yet used in our hospital. RESULTS: We reviewed 327 patients, including 20 patients (6.1%) with infections. The risk factors for infection were necrosis and/or a cavity in the tumor (p < 0.001), a large tumor diameter (≥30 mm) (p = 0.010), and a low serum albumin level (<4.0 g/dL) (p = 0.010). We developed a predictive score with these risk factors, and the area under the curve was 0.737 (95% Cl: 0.610-0.864). No significant differences in age, current smoking status, or abnormal bronchoscopic findings were observed, although these were previously reported as risk factors. In total, 12 patients had lung abscesses (3.7%), which is a higher incidence than that in 2013 (0.8%). CONCLUSIONS: The risk factors for developing post-bronchoscopy respiratory infection in our study varied from those in past reports, possibly because of the advancements in bronchoscopic techniques, such as EBUS-GS.

Serum Procalcitonin Levels Predict Mortality Risk in Patients With Pulmonary Tuberculosis: A Single-Center Prospective Observational Study.

Globally, tuberculosis is the leading infectious cause of death; discovering biomarkers that predict a high mortality risk may improve treatment outcomes. We prospectively enrolled 252 pulmonary tuberculosis patients who were not coinfected with human immunodeficiency virus and initiated antituberculosis treatment, measured serum procalcitonin levels (PCT), and assessed mortality risk. PCT serum levels higher than 0.13 (day 0), 0.05 (day 7), 0.12 (day 14), or 0.06 (day 28) ng/mL predicted nonsurvivors with odds ratios of 7.9, 14.3, 20.0, and 7.3, respectively (P ≤ .005 for all), respectively. Therefore, serum PCT levels are a promising mortality risk indicator for patients with pulmonary tuberculosis. Main Point. For patients with pulmonary tuberculosis, a promising mortality risk indicator is the level of serum procalcitonin, which is weakly associated with sputum bacterial load and independent of radiographic findings.

Limited benefit of CT scans in tuberculosis contact tracing.

OBJECTIVE: The detection of abnormal findings on computed tomography (CT) scans of tuberculosis contacts combined with normal plain radiographs contributes to the early detection of tuberculosis. However, the benefit of the early detection of abnormalities for the prevention of active tuberculosis during follow-up requires evaluation. METHOD: We conducted retrospective comparison of the existence of CT scans of tuberculosis contacts without findings of active tuberculosis on plain radiographs at a hospital in Japan. RESULTS: Among 243 contacts without CT scans, five developed tuberculosis during follow-up. Among 229 contacts with CT scans, 24 were judged as targets of multi-drug therapy since their CT findings were suggestive of active tuberculosis at the time of the CT screening. Among 205 contacts judged as having latent tuberculous infection with CT screening, three developed tuberculosis diseases during follow-up. CONCLUSION: CT scans detected abnormal findings among contacts without abnormalities of plain radiographs but there were some contacts that developed tuberculosis diseases among those with contact investigation including CT scan. The value of CT is equivocal considering the balance of true treatment, overtreatment and harm of radiation.

[THE FREQUENCIES AND MANAGEMENT OF ADVERSE REACTIONS IN MULTI-DRUG RESISTANT TUBERCULOSIS TREATMENT].

[Objectives] To investigate the adverse reactions of antimicrobial drugs in multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR- TB) patients. [Results] Sixty-six patients with MDR-TB who have been treated from 2010 through 2014 were evaluated in the retro- spective analysis. Variety of adverse reactions including psychological reaction, central nervous system toxicity, ophthalmic toxicity, peripheral neurotoxicity, gastrointestinal reactions, hematologic abnormalities, musculoskeletal adverse effects, and endocrine disorder, were observed. However, there was no fatal case due to the adverse reactions of the anti-tubercu- losis drugs in this observation. [Conclusions] Drugs for MDR-TB and XDR-TB treatment are limited and the adverse reactions of drugs for MDR-TB and XDR-TB are not well-known. Therefore, the treatment may fail due to inappropriate management of adverse events. MDR-TB and XDR-TB should be treated by the experts of the adverse reactions of all anti-tuberculosis drugs.

Immunological Roles of Elevated Plasma Levels of Matricellular Proteins in Japanese Patients with Pulmonary Tuberculosis.

Elevated matricellular proteins (MCPs), including osteopontin (OPN) and galectin-9 (Gal-9), were observed in the plasma of patients with Manila-type tuberculosis (TB) previously. Here, we quantified plasma OPN, Gal-9, and soluble CD44 (sCD44) by enzyme-linked immunosorbent assay (ELISA), and another 29 cytokines by Luminex assay in 36 patients with pulmonary TB, six subjects with latent tuberculosis (LTBI), and 19 healthy controls (HCs) from Japan for a better understanding of the roles of MCPs in TB. All TB subjects showed positive results of enzyme-linked immunospot assays (ELISPOTs). Spoligotyping showed that 20 out of 36 Mycobacterium tuberculosis (MTB) strains belong to the Beijing type. The levels of OPN, Gal-9, and sCD44 were higher in TB (positivity of 61.1%, 66.7%, and 63.9%, respectively) than in the HCs. Positive correlations between OPN and Gal-9, between OPN and sCD44, and negative correlation between OPN and ESAT-6-ELISPOT response, between chest X-ray severity score of cavitary TB and ESAT-6-ELISPOT response were observed. Instead of OPN, Gal-9, and sCD44, cytokines G-CSF, GM-CSF, IFN-α, IFN-γ, IL-12p70, and IL-1RA levels were higher in Beijing MTB-infected patients. These findings suggest immunoregulatory, rather than inflammatory, effect of MCPs and can advance the understanding of the roles of MCPs in the context of TB pathology.

[EXPERIENCE OF USE OF NEW ANTI-TUBERCULOUS DRUG, DELAMANID IN MULTI- AND EXTENSIVELY DRUG RESISTANT TUBERCULOSIS CASES IN OUR HOSPITAL].

[Objective] We experienced use of new anti- tuberculous drug, Delamanid in multi- and extensively drug resistant tuberculosis (M (X) DR-TB) in our hospital. [Materials and Methods] Fifteen cases who were diagnosed M(X)DR-TB had been used Delamanid in our hospital from 2014 to 2015. [Results] The gender distribution consisted of eleven males and four females in M(X)DR-TB. The mean age was 53.3 years old in male and 28.3 years old in female. Japanese were eight cases, and Chinese were five cases, and other countries patients were two cases. Twelve cases were MDR-TB cases, and three cases were XDR-TB cases. Six cases of fifteen cases were sputum culture positive before using Delamanid. Two cases (13.3%) had been appearanced QTc extension in EKG by using Delamanid. But these cases had not seen symptom. Other typical side effects had not seen. Six cases (40.0%) of fifteen cases had done surgical resection. One case of fifteen cases had been died with intractable pneumothorax, and one case had been discontinued for leukopenia. All cases containing two discontinued cases had obtained negative conversion of sputum culture. [Conclusion] We experienced new anti-tuberculous drug, Delamanid. If we add Delamanid only for MDR-TB patients with only one or two sensitive anti-tuberculous drugs, it will be possible to make anew resistance. We used one more another new drug, for example Linezolid or high dose isoniazid or Meropenem and Ampicilin Clavulanate acid with Delamanid and sensitive anti-tuberculous drugs. We need to investigate risk and benefit when we use new anti-tuberculous drug. We need not to make more another MDR-TB cases.

[CLINICAL EFFECTS OF TREATMENT FOR MYCOBACTERIUM TUBERCULOSIS INFECTION IN PATIENTS AT A SPECIALIZED HOSPITAL IN 2011].

OBJECTIVE AND METHODS: We analyzed the clinical effects of treatment for Mycobacterium tuberculosis infection for 1 year in our specialized hospital in 2011. Two hundred and ninety-six (296) patients were admitted and received treatment. RESULTS: Two hundred and fifty-six patients (86.5%) were started on the standard treatment with 3 drugs (isoniazid [INH, rifampicin [RFP], and ethambutol [EB] or streptomycin [SM]) or 4 drugs (INH, RFP, EB or SM, and pyrazinamide [PZA]). One hundred and seventy-one patients (66.8%) continued receiving the standard treatment during the admission period. Of 160 cases who could continue 4 drugs, under 80 year-old patients were 127 cases (76.0%), but over 80 year-old patients were 33 cases (49.3%). The mean duration for negative conversion of sputum culture was 40.6 days. Liver dysfunction due to 4 drugs (INH, RFP, EB, and PZA) was noted in 8.5% of patients. Eighteen of the 296 patients had multi-drug resistant tuberculosis (MDR-TB). Each MDR-TB patient received individualized treatment. Moreover, 7 of the MDR-TB cases were treated surgically. DISCUSSION: Treatment of TB had taken long time, and some patients could not continue the treatment owing to the adverse effects of drugs. Hence, it is important to monitor adverse effects of drugs in each patient.

[Experience of rapid drug desensitization therapy in the treatment of mycobacterial disease].

BACKGROUND: Drugs for tuberculosis and non-tuberculosis mycobacterial diseases are limited. In particular, no new drugs for non-tuberculosis mycobacterial disease have been developed in recent years. Antimycobacterial drugs have many adverse reactions, for which drug desensitization therapy has been used. PURPOSE: Rapid drug desensitization (RDD) therapy, including antituberculosis drugs and clarithromycin, has been implemented in many regions in Europe and the United States. We investigated the validity of RDD therapy in Japan. PATIENTS AND METHOD: We report our experience with RDD therapy in 13 patients who developed severe drug allergy to antimycobacterial treatment. The desensitization protocol reported by Holland and Cernandas was adapted. RESULT: The underlying diseases were 7 cases of pulmonary Mycobacterium avium complex disease and 6 cases of pulmonary tuberculosis. Isoniazid was readministered in 2 (100%) of 2 patients; rifampicin, in 8 (67.7%) of 12 patients; ethambutol, in 4 (67.7%) of 6 patients; and clarithromycin, in 2 (100%) of 2 patients. CONCLUSION: In Japan, the desensitization therapy recommended by the Treatment Committee of the Japanese Society for Tuberculosis have been implemented generally. We think RDD therapy is effective and safe as the other desensitization therapy. We will continue to investigate the efficiency of RDD therapy in patients who had discontinued antimycobacterial treatment because of the drug allergic reaction.

Activities of Daily Living, Hypoxemia, and Lymphocytes Score for Predicting Mortality Risk in Patients With Pulmonary TB.

BACKGROUND: A clinically applicable mortality risk prediction system for pulmonary TB may improve treatment outcomes, but no easy-to-calculate and accurate score has yet been reported. The aim of this study was to construct a simple and objective disease severity score for patients with pulmonary TB. RESEARCH QUESTION: Does a clinical score consisting of simple objective factors predict the mortality risk of patients with pulmonary TB? STUDY DESIGN AND METHODS: The data set from our previous prospective study that recruited patients newly diagnosed with pulmonary TB was used for the development cohort. Patients for the validation cohort were prospectively recruited between March 2021 and September 2022. The primary end point was all-cause in-hospital mortality. Using Cox proportional hazards regression, a mortality risk prediction model was optimized in the development cohort. The disease severity score was developed by assigning integral points to each variate. RESULTS: The data from 252 patients in the development cohort and 165 patients in the validation cohort were analyzed, of whom 39 (15.5%) and 17 (10.3%), respectively, died in the hospital. The disease severity score (named the AHL score) included three clinical parameters: activities of daily living (semi-dependent, 1 point; totally dependent, 2 points); hypoxemia (1 point), and lymphocytes (< 720/µL, 1 point). This score showed good discrimination with a C statistic of 0.902 in the development cohort and 0.842 in the validation cohort. We stratified the score into three groups (scores of 0, 1-2, and 3-4), which clearly corresponded to low (0% and 1.3%), intermediate (13.5% and 8.9%), and high (55.8% and 39.3%) mortality risk in the development and validation cohorts. INTERPRETATION: The easy-to-calculate AHL disease severity score for patients with pulmonary TB was able to categorize patients into three mortality risk groups with great accuracy. CLINICAL TRIAL REGISTRATION: University Hospital Medical Information Network Center; No. UMIN000012727 and No. UMIN000043849; URL: www.umin.ac.jp.

[Estimating the prevalence of tuberculosis infection among healthcare workers in our hospital by repeat QFT-G testing].

OBJECTIVE: The QuantiFERON-TB (QFT) blood test is the major tool for the diagnosis of Mycobacterium tuberculosis (TB) infection among healthcare workers (HCWs). We used QFT tests to estimate the prevalence of TB infection among HCWs in our hospital. MATERIAL AND METHODS: Between 2003 and 2010, a total of 733 HCWs were enrolled in this study, and the prevalence of TB infection was analyzed according to the HCWs' jobs and work place. RESULTS: Among the 152 men and 581 women who were evaluated, 3 female HCWs had a history of TB. Fifty-eight HCWs (8 men and 50 women with a mean age of 56.3 years and 48.4 years, respectively) demonstrated positive QFT tests. The positive rate was 7.9% for all staff members throughout the study period. The QFT test was positive for 1 HCW who was treated for TB in 1998, and negative and inconclusive for 2 other HCWs treated for TB in 2002. The positive rate for QFT was 16.0% in the TB ward (12/75, 95% confidence interval [CI]: 7.7-24.3%), 9.9% in the other wards (22/222, 95% CI: 7.9-11.9), and 1.1% in the outpatient department (1/91, 95% CI: 0-2.2). According to the job category, the QFT positive rates were as follows: doctors, 4.3% (3/70, 95% CI: 1.9-6.7); nurses, 10.3 (4/35, 95% CI: 6.0-16.8). The positive rate among doctors working in the TB ward was 10.0%, and that for nurses was 24.3%. This indicates that the prevalence of infection among HCWs in the TB ward was significantly higher than that in other work places. A comparison of the results from 2003 through 2007 revealed that for a total of 307 workers, 90.6% and 5.2% remained negative and positive, respectively, while 1.6% converted from negative to positive, and 2.6% from positive to negative. CONCLUSION: The positive rate among HCWs in the TB ward was higher than that in other wards. This is especially remarkable for doctors and nurses working in the TB ward.

[Clinical factors of pulmonary tuberculosis in non-tuberculosis wards and its incidence among contact patients and healthcare workers in our hospital using QuantiFERON GOLD testing].

OBJECTIVE AND METHODS: In our hospital, we analyzed the clinical factors of pulmonary tuberculosis (TB) diagnosed in non-TB wards and the incidence of TB infection among contact patients and healthcare workers (HCWs) using QuantiFERON-TB GOLD (QFT) testing. MATERIAL: This study included 16 patients who were diagnosed with pulmonary TB in non-TB wards in our hospital from January 2008 to May 2011. Eight contact patients and 120 HCWs were also enrolled. RESULTS: The 16 TB patients comprised 11 men (77.7 years) and 5 women (74.4 years). Among them, only 9 patients exhibited positive results for Mycobacterium tuberculosis after the first acid-fast bacterial examination; the other 7 patients presented positive results only after the second or third examinations. Moreover, there were 3 cases of positive Mycobacterium avium samples in the first acid-fast bacterial examination. Among 16 pulmonary Mycobacterium tuberculosis cases, 8 were sputum smear and culture positive, 7 were sputum smear negative and culture positive, and 1 was sputum smear and culture negative. Moreover, 17 days had elapsed from the time of admission to the non-TB ward to diagnosis. TB contact examination revealed that QFT results for 2 HCWs changed from negative to positive. DISCUSSION: We suspected pulmonary aspergillosis or old TB when presented with cases with a history of TB. Moreover, we believe that the periods from admission to diagnosis were delayed when the first acid-fast bacterial sputum examination was negative or showed non-tuberculous mycobacteria.

[Clinical experience using rifabutin for treating infection with Mycobacterium tuberculosis in elderly Japanese patients].

OBJECTIVES: To clarify whether rifabutin (RBT) can be used for treating tuberculosis in elderly Japanese patients in the clinical setting. METHOD: We performed a clinical chart review from Oct 2008 to Dec 2011, for patients who were diagnosed with tuberculosis and were prescribed rifabutin, at the Fukujuji Hospital (180 beds for respiratory medicine, including 60 for TB). Primarily, we focused on characteristics of patients, the cause for RBT indication, and success rate of treatment. RESULTS: During the study period, 1129 patients were diagnosed with tuberculosis, and among these, 42 (3.7%) patients were prescribed RBT. Of these, 39 patients were included in this study (3 were excluded because their prescription was terminated within 2 weeks because of reasons other than adverse effects). In all, 69% patients were male. Mean age was 69 years, and mean body mass index was 19.1 +/- 3.4 kg/m2. RFP-related adverse effects were observed in 28 patients (72%; age, 73 years); these included gastrointestinal complications in 16, liver dysfunction in 7, skin rashes in 6, and renal dysfunction and thrombocytopenia in 1 each). Additional medication was required in 6 patients, and RBT-resistant TB was noted in 5 patients (28%; age, 60 years). A success rate of 71.4% was observed in cases of RFP-related adverse effects, and that of 81.8% was observed in cases of other reasons. Except for the patient who experienced renal dysfunction, RBT could be used in all patients who experienced RFP-related adverse effects. CONCLUSION: RBT showed a relatively good success rate, even in patients who experienced RFP-related adverse effects. Thus, RBT could be an alternative in cases of RFP-related adverse effects, even in elderly patients.

A case of disseminated M. bovis bacillus Calmette-Guérin (BCG) disease after one month of BCG bladder infusion therapy and analysis of 77 cases of suspected BCG infection in Japan, 2017-2022.

Bacillus Calmette-Guerin (BCG) intravesical injections are used as adjuvant therapy for superficial bladder cancer. We report a case of a 78-year-old man who developed disseminated M. bovis BCG disease mimicking miliary tuberculosis early after BCG intravesical infusion. He started coughing after receiving three rounds of BCG for superficial bladder tumors, following transurethral resection of the tumors, approximately one month after initiation. Computerized tomography (CT) images showed diffuse nodular shadows in the bilateral lung fields with a random pattern. Consequently, disseminated BCG disease was diagnosed. Treatment with isoniazid, rifampicin, and ethambutol was initiated. Nine months after initiating treatment, CT showed the disappearance of the miliary shadows. We also discussed 77 cases of suspected BCG infection and the requests for Mycobacterium bovis BCG identification at our institution from 2017 to October 2022. Of these, 76 cases were M. bovis BCG, and 1 case was M. tuberculosis. Since M. tuberculosis can be identified in some patients with suspected BCG infection, it is crucial to distinguish between the two based on pathogenicity.

Relationship between the thickness of erector spinae muscles and mortality in patients with pulmonary tuberculosis.

BACKGROUND: Skeletal muscle mass is a known predictor of mortality in older patients. However, its relationship with tuberculosis is unclear. Skeletal muscle mass is determined by the cross-sectional area of erector spinae muscle (ESMCSA). Additionally, the erector spinae muscle thickness (ESMT) is an easier measurement than ESMCSA. This study investigated the relationship of ESMT and ESMCSA with mortality in tuberculosis patients. METHODS: We retrospectively collected the data of 267 older patients (age ≥65 years) who were hospitalized due to tuberculosis at the Fukujuji Hospital from January 2019 to July 2021. This included 40 patients with 60-day mortality (the death group) and 227 patients with 60-day survival (the alive group). Here, we assessed the correlations between ESMCSA and ESMT, and the data were compared between the two groups. RESULTS: ESMT had a strong proportional relationship with ESMCSA (r = 0.991, p < 0.001). ESMCSA (median 670.2 mm2 [interquartile range (IQR): 585.1-760.9] vs. 914.3 mm2 [717.6-1141.6], p < 0.001) and ESMT (median 16.7 mm [15.4-18.6] vs. 21.1 mm [18.0-25.5], p < 0.001) were significantly lower in the patients in the death group than those of patients in the alive group. A multivariable Cox proportional hazard model for 60-day mortality showed significantly independent differences in ESMT (hazard ratio [HR] 0.870 [95% confidence interval (Cl): 0.795-0.952], p = 0.003) and ESMCSA (HR 0.998 [95% Cl: 0.996-0.999], p = 0.009). CONCLUSIONS: This study demonstrated a strong correlation between ESMCSA and ESMT, which were risk factors for mortality in patients with tuberculosis. Therefore, using ESMT is easier to predict mortality than ESMCSA.

[Can an individual with a positive baseline QuantiFERON test result develop active tuberculosis?].

OBJECTIVES: QuantiFERON-TB Gold (QFT-G) test has been recommended as a new tool for the diagnosis of latent tuberculosis (TB) infection. However, the risk of development of active TB in the future depends on the period after the infection. The aim of this study was to evaluate the risk of development of active TB in individuals who have been infected. METHODS: Clinical development of TB in subjects with positive baseline QFT test results was retrospectively analyzed. The subjects included healthcare workers, since 2003, at the Fukujuji Hospital who were examined at employment. RESULTS: In total, 667 subjects were examined using the QFT-2G test, and 62 subjects were QFT positive at the first examination. One was treated using isoniazid, and 61 subjects were followed up for an average of 4.7 years (286 person-years). None of the subjects developed active TB during the observation period, and the probability of clinical breakdown (95% confidence interval) was 0-0.0104/person-year. CONCLUSION: The risk of development of active TB among subjects with positive QFT-G test results at baseline was low. Treatment of latent TB infection is not recommended, unless an individual has been recently infected.

Analysis of risk factors for pulmonary tuberculosis with persistent severe inflammation: An observational study.

INTRODUCTION: Patients with pulmonary tuberculosis (TB) sometimes show persistent severe inflammation for more than 1 month, even if TB treatment is effective. Although this inflammation can be improved through continuous antituberculous therapy, the risk factors for persistent inflammation remain unclear. Therefore, we sought to study the characteristics of patients with persistent severe inflammation. MATERIALS AND METHODS: We retrospectively analyzed 147 hospitalized adult patients with C-reactive protein (CRP) levels of 5 mg/dL or more on admission to Fukujuji Hospital from April 2019 to March 2021. The patients were divided into 2 groups: 40 patients (27.2%) had CRP levels of 5 mg/dL or more at 4 weeks after admission (persistent inflammation group), and 107 patients (72.8%) had CRP levels that fell below 5 mg/dL within 4 weeks of admission (improved inflammation group). RESULTS: The median CRP level on admission in the persistent inflammation group was 10.8 mg/dL (interquartile range 9.1-14.5), which was higher than that in the improved inflammation group (median 8.2 mg/dL [6.5-12.1], P = .002). Patients in the persistent inflammation group had a higher prevalence of large cavities, defined as cavities ≥4 cm in diameter, on chest computed tomography (CT) (n = 20 [50.0%] vs n = 12 [11.2%], P < .001). DISCUSSION AND CONCLUSIONS: This study showed that 27.2% of patients who had high or moderate inflammation on admission did not achieve low CRP levels within 4 weeks after admission. Risk factors for persistent severe inflammation in patients with TB were presence of a large cavity (cavity diameter ≥4 cm) on chest CT and a high CRP level on admission. Therefore, in a patient with a large cavity on chest CT and/or CRP ≥9.0 mg/dL on admission, long-term inflammation may occur despite antituberculous therapy if other diseases are ruled out.

[Factors related to the occurrence of multi- (extensively-) drug resistant tuberculosis (M/XDR-TB) in our hospital].

OBJECTIVE: To analyze the clinical characteristics of multi- (extensively-) drug-resistant tuberculosis (M/XDR-TB) in our hospital. MATERIALS AND METHODS: One-hundred and forty-one cases diagnosed with MDR-TB and thirteen cases with XDR-TB admitted to our hospital over the last nine years were enrolled in this study. RESULTS: The gender distribution was: ninety-nine males and forty-two females in MDR-TB and nine males and four females in XDR-TB. The mean age was 52.0 years in males and 43.1 years in females in the MDR-TB patients, and 49.1 years in males and 42.0 years in females in the XDR-TB patients. There were 11 Chinese patients and 7 Koreans, as well as 8 patients from other countries abroad. Eighty-four (59.6%) MDR-TB patients and 9 (69.2%) XDR-TB patients had a smoking history. Diabetes mellitus was seen in 30 MDR-TB and 3 XDR-TB patients. The period from manifestation to the first visit to our hospital was 41.5 months on average in the MDR-TB patients, and 79.6 months in the XDR-TB patients. The average period from first diagnosis of TB to that of M/XDR-TB was 30.9 months in the MDR and 56.8 months in the XDR. Thirty (21.3%) MDR-TB patients and one (7.7%) XDR-TB patient were first diagnosed in our hospital. One-hundred and fifteen patients (81.6%) with MDR-TB and 6 (46.1%) with XDR-TB achieved negative sputum bacteriological conversion. Fifty-six cases (48.7%) of 115 MDR-TB and all (100%) of the XDR-TB patients underwent surgical treatment. Sixteen (11.3%) MDR-TB and 3 (23.1%) XDR-TB patients died. Thirty of the MDR-TB and 1 of the XDR-TB patients had never been previously treated for tuberculosis. Twelve (8.5%) MDR-TB and 5 (38.5%) XDR-TB patients had been treated with four drugs including isoniazid (INH), rifampicin (RFP), pyrazinamide (PZA), and either ethambutol (EB) or streptomycin (SM) in previous hospitals. Twenty-five (17.7%) MDR-TB and 5 (38.5%) XDR-TB patients had been treated with three drug regimens not including PZA in previous hospitals. CONCLUSION: M/XDR-TB is a man-made disease and can be infectious. Even the current standard regimens can produce M/ XDR-TB, if they are used improperly and carelessly. Great care should be taken to prevent XDR and MDR-TB.