(Vol.73 No.4 April 1998) <1>Kekkaku Vol.73, No.4: 283-286, 1998 THE STUDIES ON TUBERCULOSIS PRESENT RESEARCH IDEAS FOR MEDIClNE Eiro TSUBURA* I started my medical career as medical mycologist following the first case of deep- seated candidiasis in Japan. On the other hand I have been seening many patients with tuberculosis as well as respiratory diseases. In my sense the seening of mycobacterial infections may still remain lot of clinical, biological or immunological research ideas in future. I did the studies on muramyl dipeptide (MDP) which derived from cell wall substance of mycobacteria. MDP seemed to be one of the enhancing immunomodulator for host defense mechanism in particular in the immunocompromised host. Key words : Medical mycology, Respitology, Host defense, Muramyl Dipeptide *From the Osaka Hospital, Anti-Tuberculosis Association Osaka Branch, 2276-1, Neya, Neyagawa, Osaka 572-0801 Japan. (Received 13 Jan. 1998) <2>Kekkaku Vol.73, No.4: 287-293, 1998 A CLlNICAL STUDY ON THE BACKGROUND OF PATIENTS WITH NONTUBERCULOUS PULMONARY MYCOBACTERIOSIS Predisposing Factor and Environment Kazuyoshi SHIMAZU*, Yoshihisa NAKAGAWA, Momoko EBIHARA, Kumiko AMAN, Mayumi SETO, Takayuki MASAKI We studied the background of 78 patients with pulmonary nontuberculous mycobacteriosis from 1992 to 1996, and 56 patients (71.8% ) were diagnosed as primary infection type and 22 patients (28.2% ) as secondary infection type. The former consisted of 17 males and 39 females (mean age }SD ; 67.4}12.9 years), and the latter consisted of 13 males and 9 fe- males (mean age }SD ; 74.0}7.5 years). Out of all 83 strains, 67 strains (80.7%) were M. avium complex, and out of 36 strains identified either M.avium or M. intracellulare, 34 strains (94.4%) were M. intracellulare and 2 strains (5.6%) were M.avium. Many patients lived in farming areas along the coast, and 35 patients (62.5%) of primary infection type and 11 patients (50%) of secondary infection type were or used to be farmers. Nine pa- tients (16.1%) of primary infection type and 6 patients (27.3%) of secondary infection type had history of gastroduodenal ulcer, while only 3 of all 78 patients had sinusitis. There was a married couple who lived in a same house and 2 sisters who lived apart who were proved to have primary infection type but cross infection was not demonstrated in either case. The development of this disease seems to be related to a genetic susceptibility and en- vironmental factors. Key words : Nontuberculous mycobacteria, Background, Residence, Occupation, Familial outbreak *From the Department of Internal Medicine, National Kumamotominami Hospital, 2338 Toyofuku, Matsubase-machi, Shimomashiki-gun, Kumamoto 869-0593 Japan. (Received 11 Aug. 1997/ Accepted 30 Oct. 1997) <3>Kekkaku Vol.73, No.4:295-306, 1998 STRUCTURE AND ANTIGENICITY OF THE GLYCOPEPTIDOLIPID ANTIGEN OF MYCOBACTERIUM AVIUM-INTRACELLULARE COMPLEX (MAC) SEROVAR 16 Keiichiro NISHIKAWA* The characteristic lipids and specific surface antigens which typify serotypes of Myco- bacterium avium-inttracellulare complex (MAC) serogroup have been examined. The char- acteristic lipids are recognized as glycopeptidolipid (GPL) antigen consisted of short- chain acylated oligosaccharides linked to long-chain fatty acyl-D-Phe-D-allo Thr-D-Ala -L-alaninol-0-3, 4-di-O-methyl rhamnose 'core'. The lack of information on the proper- ties of GPL antigen from serovar 16 and a large number of patients infected with MAC serovar 16 have prompted an examination of the chemical structures utilizing the analyti- cal techniques of alditol acetates with GC or GC/MS, and making use of FAB/MS and 1H-NMR to analyze the intact GPLs. The following structure of serovar 16 GPL antigen was proposed with molecular weight : 1933, main fatty acyl component : OH - C32 : O, and oligosaccharides : 3-amido (2'-methyl, 3'-hydroxy, 4'-methoxy pentanoyl) 3, 6-dideoxy hexose 4-0-methyl- L-rhamnose L-rhamnose L-rhamnose 6-deoxy-L-talose The unique structure may be an important factor in physiological and pathological roles. The GPL antigens were highly reactive in ELISA against sera from rabbits hyperimmunized with MAC strains, indicating its basic antigenicity. The type-specific antigen of serovar 16 was also specifically reactive against sera from patients infected with MAC serovar 16, but invariant core was not. Apparently, the epitope of GPL antigen of serovar 16 was specific oligosaccharides, 3-amido (2'-methyl, 3'-hydroxy, 4'-methoxy pentanoyl) 3, 6-dideoxy hexose. It was found that the ELISA using GPL antigens was particularly useful for the serovar diagnosis of human infections with MAC. Key words : Mycobacterium avium-intracellulare complex (MAC), Serovar 16, Glycopeptidolipid (GPL), FAB/MS, ELISA *From the Department of Bacteriology and Urology, Osaka City University Medical School, Asahimachi 1-4-54, Abeno-ku, Osaka 545-0051 Japan. (Received 27 Oct. 1997/ Accepted 19 Dec. 1997) <4>Kekkaku Vol.73, No.4: 307-314, 1998 LYMPHOCYTE CHEMOTACTIC FACTOR IN TUBERCULOUS PLEURAL EFFUSION Takashi NAITO*, Morio OHTSUKA, Hiroichi ISHIKAWA, Hiroaki SATOH and Shizuo HASEGAWA To evaluate whether lymphocyte chemotactic factor is involved in the accumulation of lymphocytes in tuberculous pleurisy, we measured lymphocyte chemotactic activity in tuberculous pleural effusions, and compared with that in malignant pleural effusions and transudate . The lymphocyte chemotactic activity was measured in vitro with chemotactic chamber. The cells suspended in the culture medium was added to the upper well and the effusions, normal human serum (NHS), or culture medium were placed below nitrocellulose filter. The lymphocyte migration was quantified by counting the number of cells migrating be- yond a distance of 70 m from top of the filter in 5 selected fields. The chemotactic ac- tivity of the effusions was expressed as a percentage of the control migration in the culture medium. When we used the freshly isolated peripheral blood lymphocytes as re- sponding cells, the chemotactic activity was 176.0 } 41.3% in tuberculous effusions, 115.1 } 53.8% in malignant effusions, 87.1 } 16.1% in transudate, and 113.3 } 24.2% in NHS, respectively. The activity of tuberculous effusions was significantly higher than that of transudate and NHS. When we used PHA-activated lymphocytes, the activity was 284.4 } 159.3% in tuberculous effusions, 123.1 } 77.6% in malignant effusions, 75.8 } 10.3% in transudate, and 52.6 } 10.1% in NHS, respectively. The activity of tuberculous effusions was significantly higher than that of malignant effusions, transudate and NHS. The chemotactic activity of tuberculous effusions to PHA-activated lymphocytes was signifi- cantly higher than that to freshly isolated lymphocytes. The activity was specific for T lymphocytes, and showed both chemotaxis and chemokinesis by checkerboard analysis. Gel filtration performed with Sephacryl S-200 revealed that the chemotactic activities in a tuberculous fluid had three peaks located in the regions between blue dextran and immunoglobulin G, near to human albumin and cytochrome c marker. The most potent activity was found at the region near human albumin. Lymphocyte chemotactic factor in tuberculous effusion may stimulate the migration of T lymphocytes, especially the activated T lymphocytes to the pleural spaces. Key words: Tuberculous pleural effusion, Lymphocyte chemotactic factor, Activated lymphocyte, Lymphocyte motility *From the Department of Respiratory Medicine, Tsukuba Medical Center Hospital,amakubo 1-3-1, Tsukuba-shi, Ibaraki 305-0005 Japan. (Received 24 Oct.1997/ Accepted 23 Dec. 1997) <5>Kekkaku Vol.73, No.4: 315-320, 1998 A CASE OF PULMONARY TUBERCULOSIS COMPLICATED WITH INTRACRANIAL TUBERCULOUS ABSCESS Tetsuro INOUE*, Nobuaki IKEDA, Takuya KURASAWA, Atsuo SATO, Kohichi NAKATANl, Takeshi IKEDA A 75-year-old male was admitted to our hospital with complaints of fever and cough. Chest X-ray showed infiltrative shadows with cavity, and sputum smears were positive for acid-fast bacilli. About 2 months after the initiation of anti-tuberculous chemother- apy, suddenly generalized convulsion occurred. CT of the brain showed the solitary mass with the ring enhancement in the left subcortical area. About 4 weeks later, brain aspira- tion drainage was performed and pus was aspirated. He was diagnosed as intracranial tuberculous abscess. After the drainage, neurological symptoms disappeared completely and there were no recurrence of abscess. Attention should be called to the complication of intracranial tuberculosis, especially in cases worsened during anti-tuberculous chemo- therapy. ' Key words : Intracranial tuberculosis, In-tracranial tuberculous abscess, Computed tomography, Transient worsening, Brain abscess *From the Department of Respiratory Medicine, National Minami-Kyoto Hospita, 11 Naka-ashihara, joyo, Kyoto 610-0113 Japan. (Received 14 Oct. 1997/ Accepted 10 Dec. 1997)