Kekkaku : [Tuberculosis]
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A case is 48 years-old Japanese man who had a history of frequent sexual contact with prostitutes in Thailand and the Philippines. He presented with chief complaint of chest discomfort in April 1995. His chest X-ray film showed right mediastinal lymph node swelling in other hospital and the sputum smear was strongly positive for acid fast bacilli. ⋯ Complications of AIDS, (Pneumocystis carinii infection, Cytomegalo virus infection, Kaposi's sarcoma, etc) other than tuberculosis have not developed to date. In the past reports, we could not find reports of bronchial tuberculosis with AIDS. Tuberculous granuloma formation was scarce in this case, and it was suspected that bronchial tuberculosis with AIDS would show characteristic sign as same as pulmonary tuberculosis with AIDS.
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We conducted a survey on nontuberculous mycobacteria (NTM) isolated in association with colonscopy at two hospitals. NTM was isolated from the fluid-phase of colonic contents in 17.6% of the specimens obtained at hospital A and in 46.3% at hospital B. The rate of isolation from the preexamination suction fluid was 9.5% and 43.3% at hospital A and B, respectively. ⋯ None of the patients from whom NTM was isolated exhibited positive signs of colonic NTM infection by the endoscopic examination and non had any underlying diseases which might induce immune suppression. We suspect that most of the NTM isolates have originated from the contaminated endoscope. In conclusion, when a colonscopic examination is carried out in suspicion of NTM disease in intestine, it is essential to reassess the possibility of mycobacterial contamination of the colonscopes and implement appropriate steps for cleansing and sterilization of them.
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Kekkaku : [Tuberculosis] · Oct 1995
Case Reports[Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated endoscope disinfection machine--on the relationship between the presence of the organism in the intestinal tract and contamination of disinfection machine, and a case of gallbladder and bile duct infection with M. chelonae].
In 1993, thirteen strains (8.7%) of M. chelonae were isolated from bronchoalveolar lavage fluid (BALF) obtained by bronchoscopy of 150 patients in Tachikawa-sogo (T) hospital, where the same automated disinfection machine was commonly used for cleaning, sterilization and disinfection of fiberbronchoscope and fibercolonoscope except 3 bronchoscopes disinfected by gas sterilization. Since January 1994, manual cleaning and sterilization has been applied for bronchoscope, and thereafter no strain of M. chelonae was isolated from BALF of 55 patients in the T hospital. While only one strain (3%) of M. chelonae was isolated from BALF of 33 patients in Ota (O) hospital, but many strains of M. chelonae were isolated from intestinal fluid obtained by fibercolonoscopy of the patients. ⋯ Thus colonoendscope may be often contaminated with the organism and subsequently the automated disinfecting machine may also be contaminated with the organism which is resist and against usual disinfection procedure, and resulted in bronchoscope contamination. If the presence of M. chelonae in intestinal tract is not rare, bile duct may be naturally infected with the organism. A case of cholecystitis and cholangitis caused by M. chelonae, which has not been reported previously, was found in the T hospital.
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Kekkaku : [Tuberculosis] · Jan 1995
Case Reports[Shortening of hospitalization period for patients with pulmonary tuberculosis].
The development of specific chemotherapeutic agents revolutionally improved the prognosis of tuberculosis and markedly shortened the duration of the treatment. Evidence of successful treatment with short-course regimens for pulmonary tuberculosis has been accumulated. But, the duration of hospitalization tends to be determined empirically and varys among hospitals and clinicians. ⋯ A number of patients with both smear and culture positive in sputum bacteriology was 210 (61.2%), and 42 cases (12.2%) were smear negative and culture positive. The results are as follows: (1) Mean duration of hospitalization in the years 1984, 1988, and 1991 were 141, 102, and 72 days, respectively. That is, a mean hospitalization period was shortened to about half during these seven years. (2) According to the chest x-ray classification (Group A: I, II3, B: II1, II2, III3, C: III1, III2), mean durations of hospitalization were 186 days for group A, 143 days for group B, and 108 days for group C in 1984, and 96 days, 76 days, and 59 days in 1991, respectively. (3) According to sputum bacteriology, mean durations of hospitalization were 169 days for (S+/C+) cases, 105 days for (S-/C+) cases, and 90 days for (S-/C-) cases in 1984, and 83 days, 67 days, and 41 days in 1991, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)