(Vol.75, No.5 May 2000) <1> Kekkaku Vol.75, No.5: 379-388,2000 PROTECTIVE EFFICACY OF BCG TOKYO 172 IN THE GUINEA PIG MODEL OF PULMONARY TUBERCULOSIS 1,2Toshiko YAMAMOTO, 2Susan PHALEN, 3Kazuyuki UCHIDA, 1Kiyoko UMEMORI, 1Yasuhiro NOJIMA, 4Yoshinobu HORIUCHI, 5Yoshitaka GOTO, 2David N. MCMURRAY, and 1*Saburo YAMAMOTO 1*Dept. Bacterial & Blood Products, National Institute of Infectious Diseases, 2Dept. Medical Microbiology & Immunology, College of Medicine, Texas A & M University, 3Dept. Veterinary Pathology, Miyazaki University, 4Dept. Safety Research on Biologics, National Institute of Infectious Diseases, 5Dept. Veterinary Microbiology, Miyazaki University BCG Tokyo 172 strain was examined for its protective efficacy against pulonary tu- berculosis in a guinea pig model. Guinea pigs were vaccinated with an intradermal injec- tion of 10(3) CFU of BCG Tokyo 172 strain. BCG Copenhagen 1331 was employed as a control strain. Eight weeks after the vaccination, the animals were infected with about 10 CFU of M. tuberculosis H37Rv by a respiratory route in an aerosol chamber. Five weeks after infecton, the animals were euthanized and their spleens, lungs and livers were obtained for enumeration of M.tuberculosis H37Rv and histopathological examina- tions. The mean log(10) CFU of M.tuberculosis H37Rv recovered form right lower lung lobes of guinea pigs vaccinated with BCG Tokyo 172 (frozen), BCG Tokyo 172 (freeze- dried), BCG Copenhagen 1331 (freeze-dried) and placebo were 4.72, 4.23, 4.35 and 5.76, respectively. The mean log(10) CFU of the bacteria recovered from spleens were 2.11, 1.51, 1.37 and 5.90, respectively. There was a significant difference in bacterial recovery form both lung and spleen between the vaccinated and the non-vaccinated groups. No significant difference was seen among the groups vaccinated with different strains of BCG in any organ. The lungs exhibited just small granulomatous nodules and the spleens showed no granulomatous nodules in the BCG-vaccinated guinea pigs. On the other hand, the lungs and spleens from non-vaccinated guinea pigs showed much larger granulomatous nodules with central necrosis. These histopathological difference between the vaccinated and the non-vaccinated guinea pigs was consistent with the difference of bacterial growth between them. The results of this study have clearly indicated that BCG Tokyo 172 strain possesses a significant protective efficacy against M.tuberculosis as well as BCG Copenhagen 1331 strain. These results have also shown that the respiratory infection model in guinea pigs is very useful to evaluate efficacy of vaccines against pulmonary tuberculosis. Key words:BCG, Vaccination, Protective efficacy, Experimental airborne tuberculosis, Guinea pig pulmonary tuberculosis *4-7-1, Gakuen, Musashimurayama-shi, Tokyo 208-0011 Japan. (Received 9 Nov. 1999/Accepted 24 Jan. 2000) <2> Kekkaku Vol.75, No.5: 389-394,2000 AN OUTBREAK OF PULMONARY TUBERCULOSIS IN THE DORMITORY OF CONSTRUCTION LABORS SUSPECTED TO HAVE BEEN DUE TO EXOGENOUS REINFECTION 1*Takuya KURASAWA, 1Atsuo SATO, 1Koichi NAKATANI, 1Takashi IKEDA, 1Harukazu YOSHIMATSU, 1Nobuaki IKEDA, 2Tetsuro INOUE, and 3Koichi KANAI 1*Division of Respiratory Medicine, National Minami-Kyoto Hospital,2Division of Respiratory Medicine, Tenri Hospital, 3Kyoto Prefectural Uji Public Health Center We report an outbreak of pulmonary tuberculosis (TB) in a dormitory of construction labors, and this outbreak is suspected to have been caused by exogenous reinfection, based on the restriction fragment length polymorphism (RFLP) analysis and other findings. After a patient entered our hospital with active TB, 12 new other patients were discoverd by contacts examination. These patients lived together in the same dormitory. They were all male and single, and were aged from 43 to 63 years old. Except one patient (No.3) previously treated for TB for three months about 2 Years ago and was suspected to be the index case of this outbreak, 12 other patients did not have a medical history of TB. The bacilli cultured from 11 patients (No.1-11) were tested by RFLP analysis, three patterns were identified, and the fingerprints from 9 patients (No.1-9) were identical, and the patterns of incomplete resistance of some antituberculous drugs were quite similar between No.1-9 and No.12 and between No.10 and No.13, respectively. The locations of the main lesions of TB on chest X-ray pictures were the apico- positerior segments of bilateral upper lobes. No signs suspected to indicate primary tuberculosis were detected. Considering the rate of tuberculous infection in Japan among the middle age and above as well as the identical RFLP results, most of patients in this outbreak except the index case No.3 were suspected to have TB due to the exogenous reinfection. Key words:Pulmonary tuberculosis, Outbreak, Reinfection, RFLP analysis, Elderly group *11, Naka-Ashihara, Joyo-shi, Kyoto 610-0113 Japan. (Received 2 Sep. 1999/Accepted 14 Feb. 2000) <3> Kekkaku Vol.75, No.5: 395-401,2000 ACUTE RESPIRATORY FAILURE CAUSED BY TUBERCULOSIS REQUIRING MECHANICAL VENTILATION 1,2*Goh TANAKA, 1Hideaki NAGAI, 3Akira HEBISAWA, 1Yoshiko KAWABE, 1Kazuko MACHIDA, 1Atsuyuki KURASHIMA, 1Hideki YOTSUMOTO, and 1Masashi MORI 1Department of Respiratory Diseases, National Tokyo Hospital, 2*Department of Respiratory Diseases, Tokyo University School of Medicine, 3Department of Pathology, National Tokyo Hospital The patients with active tuberculosis in whom respiratory failure requiring mechanical ventilation developed were studied retrospectively. Nine patients (M8, F1) were identified at the National Tokyo Hospital during 5 years from January, 1993 to December, 1997. Seven of 9 patients were single men, and the duration of symptoms before admission was over 1 month in all patients, while the time from first visit to diagnosis was less than 7 days. All patients were identified as malnourished, and 7 patients suffered from another underlying diseases. The patients were classified into two groups. Six of 9 patients had pulmonary tuberculosis and the other three had miliary disease. The proportion of cases requiring mechanical ventilation was 0.3% and 8.6%, respectively, in pulmonary tuberculosis and miliary tuberculosis. At the start of mechanical ventilation, Pao2/FIO2 was lower than 200 in all 9 patients, and 6 patietns were probably ARDS. Steroids (methylprednisolone 250`1000mg/day) were used in all 9 patients. Despite the use of mechanical ventilation and antituberculous therapy, 8 out of 9 patients died. Only one patient with miliary tuberculosis survived. The establishment of the therapy for acute raspiratory failure is needed so as to improve prognosis of such cases. At the same time, the delay in consulting a doctor led to acute respiratory failure in most cases, so it is also important to encourage tuberculosis patients to visit a doctor as soon as possible, after the appearance of symptoms. Key words:Pulmonary tuberculosis, Miliary tuberculosis, Acute respiratory distress syndrome(ARDS), Mechanical ventilation, Steroid *7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655 Japan. (Received 27 Sep. 1999/Accepted 21 Feb. 2000) <4> Kekkaku Vol.75, No.5: 403-407,2000 A CASE OF PRIMARY TUBERCULOSIS, WITH SUBPLEURAL INFILTRATIVE SHADOW, HILAR LYMPHADENOPATHY PERFORATED INTO BRONCHUS, CAUSING TUBERCULOUS PNEUMONIA 1,2*Tetsuro INOUE, 1Nobuaki IKEDA, 1Takuya KURASAWA, 1Atsuo SATO, 1Kohichi NAKATANI, 1Takeshi IKEDA, and 1Harukazu YOSHIMATSU 1Department of Respiratory Medicine, National Minami-Kyoto Hospital, 2*Department of Respiratory Medicine, Tenri Hospital A 47-year-old asymptomatic female was referred to our outpatient department with pulmonary infiltration in the left S(6). PPD skin test revealed 12~11mm redness. The infiltration disappeared without treatment. Hilar lymphadenopathy appeared 2 months after the first visit. In 6 months after the first visit, the hilar lymphadenopathy disappeared without treatment, but infiltration appeared in the left S(6)(different site to that of the first visit). Arepeated PPD revealed 47~40mm redness and 20~15mm induration. Bronchoscopy revealed a polipoid lesion at the orifice of left B(6), MTD(Mycobacterium tuberculosis direct test) was positive from the bronchial washing of left B(6). She was diagnosed as tuberculosis based on the courses and radiographic appearances. After antituberculous chemotherapy, the pulmonary infiltration and the polipoid lesion at the orifice of left B(6) improved. Key words:Primary tuberculosis, Hilar lymph node tuberculosis, Bronchial tuberculosis, Tuberculous caseous pneumonia, Endobronchial polyp *200, Mishima-cho, Tenri-shi, Nara 632-8552 Japan. (Received 10 Sep. 1999/Accepted 22 Dec. 1999)