Kekkaku : [Tuberculosis]
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Kekkaku : [Tuberculosis] · Mar 2010
Case Reports[A case of cardiac tamponade caused by tuberculous pericarditis].
An 86-year-old male was admitted to Izumikawa Hospital complaining of fever and chest pain. Electrocardiography revealed low-voltage, atrial fibrillation and QRS complexes. The chest PA-view showed an increased cardiothoracic ratio (65.9%) and an infiltrative shadow in the left lower lung field. ⋯ The adenosine deaminase activity of the pericardial fluid was 77.2 IU/l, and testing for tuberculous bacilli by polymerase chain reaction was positive. As these parameters strongly suggested tuberculous pericarditis, pericardial drainage was continued for another two weeks, and a delayed combination therapy with isoniazid, rifampicin, streptomycin, and a high dose of prednisolone was initiated. Two weeks later, the symptoms were relieved and the pericardial effusion had also decreased.
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Kekkaku : [Tuberculosis] · Jan 2010
Fighting the tuberculosis epidemic in the Western Pacific region: current situation and challenges ahead.
Tuberculosis (TB) remains a major public health problem in the Western Pacific Region. More than 20% of the global burden of TB is found in the Region. In 2007, the latest year for which data is available, there were an estimated 1.9 million incident cases (109 per 100,000 population). Four countries (Cambodia, China, the Philippines and Vietnam) account for 93% of the total estimated incident cases in the Region. Every year an estimated 300 thousand persons die due to TB. The Region is host to an estimated 135,000 multi-drug resistant TB cases, most of which can be found in China. ⋯ In spite of the substantial progress made in most countries with a high burden of TB, substantial challenges remain in the Region. The rate of decline in TB prevalence and mortality is too low to reach the 50% reduction goal in 2010. It will be necessary to further increase TB case detection and address the emerging spread of drug-resistant TB. The slow response in the most affected countries in the Region is a cause for concern. Strong commitment by national governments and their partners is needed to sustain and further strengthen the current TB control efforts.
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Before the availability of high-resolution genotyping tools in 1990s, there was a prevailing dogma of little genomic sequence diversity in Mycobacterium tuberculosis. Due to the low levels of genetic variation, it was assumed that M. tuberculosis exhibit very little phenotypic variation in immunologic and virulence factors. The fingerprinting method based on restriction fragment length polymorphisms (RFLP) of IS6110 insertion sequences had unveiled the underestimation of the sequence variation in M. tuberculosis and the importance of strain-to-strain variation for understanding pathogenesis, immune mechanisms, bacterial evolution, and host adaptation. ⋯ The other example we showed: we can know relapse, reinfection, or laboratory contamination by using VNTR in a few days when a patient shows bacteriological relapse during the treatment. By introducing VNTR to clinical practice, we can diminish days of inappropriate hospitalization. Because VNTR data are numerical, we can easily construct VNTR database, compare data, and survey emergence of MDR/XDR-tuberculosis.
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Kekkaku : [Tuberculosis] · Dec 2009
[Population structure analysis of Mycobacterium tuberculosis Beijing family in Japan].
The Beijing family is a genotypic lineage of M. tuberculosis that reportedly predominates throughout eastern Asia and in parts of Russia yet dispersed worldwide. About 80% of clinical isolates in Japan are belonging to this family. The predominance of a narrow range of genotypes, in this case predominance by Beijing family strains, hypothesized that these strains may have a selective advantage either with virulence or transmissibility that led to clonal expansion. ⋯ In the combination of molecular epidemiological data with recent advances in mycobacterial genomics and population genetics, we could provide novel insights into genetic diversity and phylogeny of M. tuberculosis Beijing family strains circulating in Japan. This would be a good start to approaching the genetic determinants causing variations in virulence and transmissibility of M. tuberculosis. We are currently applying the next-generation sequencing technology to get the whole genome sequencing of the representative strains from each monophyletic subgroup within M. tuberculosis Beijing family.
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Chest X-ray examination had been used rather soon after the discovery of X-ray by Rontgen K in 1895 as it was possible to detect chest abnormality by simple radiography. After the discovery of radiophotography independently by Abreu M and Koga Y in 1936, it was applied as a method of mass screening for TB in Japan, and Imamura A made a special lecture on "The mass screening for TB" using radiophotography in 1940 in the Annual Meeting of the Japanese Society for TB. From experiences of mass screening, it was found that there were many cases of TB who do not aware of their own disease, and to know the prevalence of TB, the screening of survey subjects by X-ray examination is indispensable. ⋯ In the age groups above 40, the prevalence of any TB finding, as well as of healed and calcified findings was very high, while the coverage of BCG vaccination was below 20%. BCG vaccination was started in Japan in 1943, and those above 40 years of age in 1963 were then already 20 years of age or above, and only few were vaccinated with BCG when BCG vaccination was expanded to cover higher age groups thereafter. TB prevalence survey has now come to be used as one of methods to estimate the incidence of TB under the impact of HIV/AIDS epidemic, and its significance is now re-evaluated.