(Vol.75 No.8 August 2000) <1> Kekkaku Vol.75,No.8:493-498,2000 TWO-STEP TUBERCULIN SKIN TESTING IN OUR HOSPITAL EMPLOYEES *Shuichi YANO, Shinji SHISHIDO, Masaaki MIKAMI, Kanako KOBAYASHI, Hiroko NAKANO, and Yuji KAWASAKI *Department of Pulmonary Medicine, National Sanatorium Matsue Hospital To evaluate the baseline values of tuberculin reaction, two-step tuberculin skin testing was carried out in 365 employees of our hospital. We defined strongly response group when the size of erythema showed more than 30 mm or who showed strongly positive reaction. Two-step tuberculin skin testing was carried out in 165 hospital employees excluding those who were defined as the strongly response group in the first testing. 80 hospital employees (48.5%) became strongly response group by the second tuberculin skin testing. Altogether, 76.7% of all employees were strongly response group either by the first time or the second tuberculin skin testing. The size of erythema and that of induration showed 13.2}12.6mm (mean}SD), 6.9}9.2mm increase, respectively, in the Two-step tuberculin skin testing, so-called Booster phenomenon. We could not know the true tuberculin reaction status by the single tuberculin skin testing. Therefore, two-step tuberculin skin testing is important as one of an infection prevention countermea- sures in the hospital workers. Key words:Two-step tuberculin skin testing, Hospital employees, Booster phenomenon *5-8-31, Agenogi, Matsue-shi, Shimane 690-8556 Japan. (Received 13 Mar. 2000/ Accepted 17 May 2000) <2> Kekkaku Vol.75,No.8:499-504,2000 TRANSITIONAL PATTERN OF THE CLINICAL FEATURES OF PATIENTS WITH PULMONARY TUBERCULOSIS IN A COMMUNITY HOSPITAL 1*Yoshihiro KOBASHI, 1Hirohide YONEYAMA, 1Niro OKIMOTO, 2Toshiharu MATSUSHIMA, and 3Rinzo SOEJIMA 1*Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School Kawasaki Hospital, 2Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, 3Kawasaki Medical Welfare Universtiy To determine changes in the clinical features of recent patients with pulmonary tuber- culosis in a community hospital without restricted tuberculosis wards, the clinical find- ings of 112 patients with pulmonary tuberculosis (containing miliary tuberculosis) during the past 15 years were compared by dividing the patients into three groups, each encompassing a five-year period. Recently, the number of patients with pulmonary tuberculosis was found to be increas- ing in a community hospital. In particular, the percentages of elderly patients and smear positive patients have increased. However, because of the improving awareness on tuber- culosis, we have diagnosed TB cases correctly on admission and tended to preform the ap- propriate treatment. The comparative study between pulmonary tuberculosis patients diagnosed at the outpatients department and diagnosed after admission indicated that the patients diagnosed after admission showed pneumonia-like infiltrative shadows with- out cavity formation and lower smear positivity for tubercle. Fortunately, resistance to antituberculous drugs of isolated tubercle bacilli in our community hospital has not yet increased and the prognosis of the cases proved to be good when the appropriate treat- ment was performed at an early stage. Key words:Community hospital, Tuberculosis, Transitional pattern *2-1-80, Nakasange, Okayama-shi, Okayama 700-8505 Japan. (Received 14 Feb. 2000/ Accepted 18 May 2000) <3> Kekkaku Vol.75,No.8:505-509,2000 MANAGEMENT OF PULMONARY TUBERCULOSIS PATIENTS COMPLICATED WITH DIABETES MELLITUS BEFORE DIAGNOSIS AS PULMONARY TUBERCULOSIS AND FEASIBILITY OF CHEMOPROPHYLAXIS *Fumio YAMAGISHI, Yuka SASAKI, Takenori YAGI, Hideki YAMATANI, Fuminobu KURODA, and Hideaki SHODA *Division of Thoracic Disease, National Chiba Higashi Hospital We studied whether diabetics who are one of the high risk groups of developing pulmo- nary tuberculosis had undergone chest X-ray examination periodically. The feasibility of chemoprophylaxis in diabetics was also studied by investigating whether fibrotic lesions of tuberculosis can be found on previous chest X-ray films of these patients. Of the pulmonary tuberculosis patients admitted to our hospital for treatment, 78 pa- tients complicated with diabetes mellitus were enrolled in this study. As to the mode of detection, the majority, 63 cases, are discovered, by undergoing medical examination be- cause of respiratory symptoms, followed by 8 patients in whom pulmonary tuberculosis was found by health examination and only 1 patient was found by the periodic observa- tion of diabetes mellitus. Of the 57 patients receiving the original treatment for pulmonary tuberculosis preceded by the discovery of diabetes mellitus, only 15 (26%) had undergone chest X-ray exami- nation periodically. This fact shows that physicians treating diabetes mellitus have only a little concern on tuberculosis, thus the re-training of physicians dealing with diabetics on tuberculosis is considered to be necessary. According to chest X-ray films of 21 pa- tients who had undergone chest X-ray examination and in whom the previous films were avaiable, there were 6 patients without any lesion of pulmonary tuberculosis, 8 patients with fibrotic lesions and 7 patients with active lesions. The 8 patients showing fibrotic lesions have developed pulmonary tuberculosis on the average 15 years after they were diagnosed with diabetes mellitus, and the fact suggests that the prevention of the devel- opment of pulmonary tuberculosis among diabetics could be possible by chemopro- phylaxis. Key words:Pulmonary tuberculosis, Diabetes mellitus, High risk group, Chemoprophylaxis *673, Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712 Japan. (Received 10 Mar. 2000/ Accepted 26 May 2000) <4> Kekkaku Vol.75,No.8:511-516,2000 STUDY OF THE TWO-STEP TUBERCULIN TESTS AND GAMMA-INTERFERON ASSAYS IN ELDERLY PERSONS 1*Akira SUDA, 2Kiminori SUZUKI, 2Akimitsu SHIMURA, 3Tatsuhiro NAKATANI, 4Toru MORI, 4Nobuyuki HARADA, 4Kazue HIGUCHI, and 1Takayuki KURIYAMA 1:Department of Chest Medicine, Chiba University School of Medicine, 2Chiba Anti-Tuberculosis Association, 3Chiba Minami Hospital, 4Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association Recently, an outbreak of lung tuberculosis among elderly residents happened in the home for aged, and it has become a social problem. To analyze the problem of tuber- culosis in the elderly persons, we performed two-step tuberculin tests at two weeks interval and gamma-interferon assays for diagnosis of human tuberculosis to resi- dents in the home for aged. 45 males (age;77.3}8.9 SD) and 118 females (age;81.9} 8.6 SD) elderly persons (60) were examined. Standard dose of PPD was injected intracutaneously, and read at 48 hours. Erythema of 10mm diameter or more was consid- ered positive. The results were as follows. (1)The percentages of positive reactors in the 1st (T1) and the 2nd (T2) tuberculin tests were 50.3% and 68.1%, respectively. (2)The di- ameters of erythema and percentage of positive reactors (T1) did not vary with age, but the size of erythema increased from 13.5mm (T1) to 21.2mm (T2) among those below 80years, and from 13.0mm (T1) to 16.4mm (T2) among those 80 years or higher (p0.01). (3)The percentage of positive reactors (T1) varied by sex, namely males react stronger than females. (4)A dose of interferon-released specifically in response to PPD stimulation of whole blood cultures showed no close relation with the diameters of erythema. In conclusion, tuberculin reactivity waned among elderly persons, and the fact suggests that they would have lower resistance against new infections, and as a result, they might have higher risk of developing tuberculosis. Elderly residents should be performed two-step tuberculin tests at the time of their entrance to the home for aged, and negative reactors should carefully be followed up. Key words:Pulmonary tuberculosis, Elderly persons, Two-step Tuberculin testing, Interferon-gamma *1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670 Japan. (Received 20 Apr. 2000/ Accepted 7 Jun. 2000) <5> Kekkaku Vol.75,No.8:517-520,2000 The 75th Annual Meeting Lunch-Time Seminar STUDY ON RECOMBINANT BCG *Takeshi YAMADA *Nagasaki University The progress of study on recombinant BCG was stated brifly. And then our studies on recombinant BCG were mentioned. Recombinant BCG secreting antigen-fused merozoite surface protein 1 (MSP1) was prepared and tested for its ability to control infections of Plasmodium yoelii. Result turned out it controlled the infection better than recombinant MSP1 mixed with Freund incomplete adjuvant did. Recombinant BCG secreting excess amounts of antigen 85 complex A controlled infection of Mycobacterium leprae. Addition of recombinant BCG secreting antigen-fused IL-2 to periotneal exudate cells in- duced IFN- resulting in killing bladder cancer cells more efficiently than parental BCG did. Key words:recombinant BCG, Malaria vaccine, Vaccine against leprosy, recombinant vaccine against bladder cancer *2-20-6, Sakamoto, Nagasaki-shi, Nagasaki 852-8102 Japan. (Received 12 Jun. 2000)