(Vol.79, No.7 July 2004) <1>Kekkaku Vol.79, No.7:431-435,2004 Original Article CLINICAL EVALUATION ON ISOLATION OF MYCOBACTERIUM KANSASII IN OUR HOSPITAL Tetsuro INOUE, Eisaku TANAKA, Terufumi KATO, Minoru SAKURAMOTO, Yuji MAEDA, Ko MANIWA, and Yoshio TAGUCHI Abstract [Materials and Methods] We retrospectively evaluated 49 cases from whom Mycobacterium kansasii(MK) was isolated from 1992 to 2001 in our hospital. [Results] The annual numbers of MK patients have increased. One of the clinical characteristics of patients in our cases was relatively low rate of cavitary lesions. In 13 patients who had not fulfilled the diagnostic criteria of MK infection, the clinical disease due to MK did not appear at all during observation period ranging one month to ten years. [Conclusion] These findings suggest that MK isolation from clinical specimens is not always considered clinically significant, but may be colonization. Key words:Nontuberculous mycobacteriosis, Atypical mycobacteriosis, Mycobacterium kansasii, Diagnostic criteria Department of Respiratory Medicine, Tenri Hospital Correspondence to:Tetsuro Inoue, Department of Respiratory Medicine, Tenri Hospital, 200, Mishimacho, Tenri-shi, Nara 632-8552 Japan. (E-mail:tetsuinoue@tenriyorozu-hp.or.jp) <2>Kekkaku Vol.79, No.7:437-441,2004 Original Article MYCOBACTERIUM SHINSHUENSE ISOLATED FROM CUTANEOUS ULCER LESION OF RIGHT LOWER EXTREMITY IN A 37-YEAR-OLD WOMAN 1Yuko KAZUMI, 1Koji OHTOMO, 1Mitsuyoshi TAKAHASHI, 1Satoshi MITARAI, 1Isamu SUGAWARA, 2Junko IZUMI, 2Akiko ANDOH, and 3Hidehiro HASEGAWA Abstract [Purpose] Second clinical infection case of Mycobacterium shinshuense was presented, we tried the identification of M.shinshuense that is isolated from skin. [Object] Mycobacteria species isolated from Cutaneous ulcer lesion of right lower extremity in a 37-year-old wonan. [Method] Identification by DNA-DNA Hybridization, 16S rRNA and rpoB method as genomic level and conventional method. [Result] It did not grow on 1% Ogawa's slant medium at both 37Ž and 42Ž, but grew at 28Ž. It formed yellowish colonies in the dark. It was difficult to distinguish M.shinshuense from M.ulcerans and M.marinum by DNA-DNA hybridization(DDH) and DNA sequencing. To identify that it is M.shinshuense, growth rate, temperature range of mycobacterial growth, light coloration reaction, biochemical and biological tests, and drug susceptibility testing were further explored. Finally it was identified as M.shinshuense based on these results. [Consideration] For Mycobacteria species which grow 2 weeks after inoculation at 28Ž, and which is identified as M.marinum by DDH method, it is necessary to identify with sequence and conventional method. Key words:Mycobacterium shinshuense, Skin ulcer, DDH, 16S rRNA method, rpoB gene 1Mycobacterium Reference Center, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), 2Nagaoka General Central Hospital, JA Niigata-ken Kouseiren, 3Pahtology Center, JA Niigata-ken Kouseiren Correspondence to:Yuko Kazumi, TB Information Division (Molecular Epidemiology & Genetic Identification), Mycobacterium Reference Center, Research Institute of Tuberculosis, JATA, 3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533 Japan. (E-mail:kazumi@jata.or.jp) <3>Kekkaku Vol.79, No.7:443-448,2004 Original Article EVALUATION OF QUANTITATIVE FIT-TESTING OF N95 FILTERING FACEPIECE RESPIRATORS USING MASK-FITTING TESTER AND IMPROVEMENT OF MASK FITTING BY INSTRUCTION 1Yoshiko KAWABE, 2Shigeru TANAKA, 1Hideaki NAGAI, 1Junko SUZUKI, 1Atsuhisa TAMURA, 1Naohiro NAGAYAMA, 1Shinobu AKAGAWA, 1Kazuko MACHIDA, 1Atsuyuki KURASHIMA, and 1Hideki YOTSUMOTO Abstract [Objective] To evaluate quantitative fitness of N95 filtering facepiece respirators (N95 Mask) using Mask Fitting Tester and improvement of fitness by instruction. [Materials and Methods] One hundred and thirty- three health care workers working at our hospital were tested as to quanti- tative fitness of N95 Mask using Mask Fitting Tester Model MT-02(TM), Roken type that counts particles more than 0.7ƒÊm in diameter. Based on counting the number of particles more than 0.7ƒÊm in diameter of the air inside and outside the mask, leakage rate is calculated. Permissible range of leakage rate is 10% or below. In case of leakage rate more than 10%, we instructed way of wearing N95 Mask or change a type of N95 Mask. We usually provide three types of N95 Mask. [Results] Eighty-seven (65.4%) out of 133 health care workers achieved leakage rate 10% or below at the first test. Forty-six (34.6%) who did not achieve leakage rate 10% or below at the first test received instruction or changed a mask type. Twenty-one (15.8%) achieved desired value by instruction and 19 (14.3%) by changing a mask type. But 6 (4.5%) could not achieve desired value in spite of instruction or changing to another type of masks available to us. Leakage rate changed from 20.5}10.9% (10.1-58.6) to 6.3}4.9% (0-29.5) by instruction or changing a type of mask (p<0.001). At the first test, mask fitness is better in male than female, and worse in workers who always use N95 Mask at isolation ward or laboratory room than workers who usually do not use N95 Mask. Main problems were choise of mask, fitness to nose, incorrect use of headband. [Conclusion] It is useful to evaluate N95 Mask quantitative fitness using Mask Fitting Tester Model MT-02(TM), Roken type. At the first test, 34.6% of health care workers have large amount of leakage more than 10%, and by instruction or changing a mask type, most of them could achieve 10% or below. But 4.5% could not achieve desired value. On Infection control, it is important to test quantitative fitness of N95 Mask and to provide more than three types of N95 Mask. Key words:Tuberculosis, N95 filtering facepiece respirator, Fitting test, Mask Fitting Tester, Leakage rate, Infection control 1Department of Respiratory Disease, National Hospital Organization Tokyo National Hospital, 2Division of Food and Nutrition, School of Human Life Science, Jumonji University Correspondence to:Yoshiko Kawabe, Department of Respiratory Disease, National Hospital Organization Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585 Japan. (E-mail:kawabe@tokyo.hosp.go.jp) <4>Kekkaku Vol.79, No.7:449-451,2004 Case Report PSEUDO-RECURRENCE OF LUNG TUBERCULOSIS BASED ON THE DETECTION OF SMEAR AFB POSITIVE SPUTUM DUE TO EXCRETION OF NECROTIC MATERIAL Kunihiko ITO Abstract A 21-year-old man was admitted to our hospital for cough and hemoptysis. The patient showed smear positive pan-sensitive lung tuberculosis, and completed standard course of chemotherapy successfully. Six months after the completion of chemotherapy he had hemoptysis again. The chest radiograph showed that pre-existing tuberculoma-like shadow in the right upper lobe was changed to a cavity. Although sputum smear examinations revealed positive results several times, sputum culture was always negative. This clinical exacerbation was thought to be "pseudo-recurrence" due to excretion of necrotic material from the pre-existed abscess nodule. His disease improved without any anti-tuberculosis chemotherapy. Diagnosis of lung tuberculosis recurrence should be made on sputum culture positive results. Key words:Paradoxical exacerbation, Pseudo-recurrence, Cavity, Recurrence, Smear positive culture negative Department of Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association Correspondence to:Kunihiko Ito, Department of Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533 Japan. (E-mail:ito@jata.or.jp) <5>Kekkaku Vol.79, No.7:453-457,2004 Case Report A CASE OF CERVICAL AND MEDIASTINAL LYMPH NODES TUBERCULOSIS, TUBERCULOUS PLEURISY, SPINAL CARIES AND COLD ABSCESS IN THE ANTERIOR CHEST WALL Yasuhiro IWATA, Akiko ISHIMATSU, Minako HAMADA, Mikiko EMORI, Yukari IKEDO, Kentaro WAKAMATSU, Nobuhiko NAGATA, Akira KAJIKI, Yasuko HARADA, Susumu HARADA, and Yoshinari KITAHARA Abstract A 61-year-old woman with schizophrenia that had been treated in a psychiatric hospital was admitted to our hospital because of subileus and back pain. Though subileus was improved, she had a sudden attack of fever 7 days later and developed right pleural effusion, a cold abscess in the anterior chest wall and swelling of a thumb-sized right cervical lymph node which broke through the skin. We made a diagnosis of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall due to the biopsy findings of the specimen taken from the cervical lymph node, examination of pleural effusion, chest CT, bacteriological examination of the cold abscess and spinal MRI. We started chemotherapy with the antituberculous drugs (HRSZ) and symptoms except back pain improved. She complained of paresis of the both lower extremities, which completely paralyzed 8 months later in spite of continued chemotherapy. Thereafter her paralysis was gradually improved and she was able to walk by herself after 12 months chemotherapy. Key words:Extrapulmonary tuberculosis, Cervical lymph node tuberculosis, Mediastinal lymph node tuberculosis, Tuberculous pleurisy, Spinal caries, Cold abscess Department of Intermedicine, National Omuta Hospital Correspondence to:Yasuhiro Iwata, Department of Intermedicine, National Omuta Hospital, 1044-1, Tachibana, Omuta-shi, Fukuoka 837-0911 Japan. (E-mail:renkei@oomuta.hosp.jo.jp)