(Vol.76 No.10 October 2001) <1> Kekkaku Vol.76, No.10:649-656,2001 SURGICAL MANAGEMENT OF NON-TUBERCULOSIS MYCOBACTERIOSIS AND TUBERCULOSIS OF THE LUNG 1*Noburu NAKANO,2Takeshi HIRAYAMA, 2Masahiro ABE, 2Kazutaka NISHIMURA, and 3Tsuneo IMACHI 1*Department of Surgery II, School of Medicine, Ehime University, 2Department of Respiratory Medicine, and 3Department of Surgery, National Sanatorium Ehime Hospital From 1990 to 1999, three patients with non-tuberculous mycobacteriosis and 14 patients of tuberculosis underwent pulmonary resection in the National Sanatorium Ehime Hospi- tal. Of the patients with tuberculosis, two were multiple drug-resistant cases and twelve cases were suspected of lung cancer before diagnostic resection. All three patients with non-tuberculous mycobacteriosis were symptomatic, had chest cavities in the lung, and were sputum-culture positive. There were no operative death in all patients, and one case of post-operative complica- tion. Two patients, one with non-tuberculous mycobacteriosis and another with tubercu- losis, failed in sputum negative conversion. The former had been treated for a long time preoperatively. Early resection in patents of pulmonary non-tuberculous mycobacteriosis and of pul- monary multiple drug-resistant tuberculosis is recommended to prevent further progres- sion of pulmonary lesions. Key words:Lung, Non-tiberculous mycobacteriosis, Tuberculosis, Surgery, Indication for operation, Multiple drug-resistance *Shizugawa, Onsen-gun, Ehime 791-0295 Japan. (Received 31 Jan. 2001/Accepted 20 Jun. 2001) <2> Kekkaku Vol.76, No.10:657-662,2001 EVALUATION OF THE BACTEC MGIT 960 SYSTEM FOR DRUG SUSCEPTIBILITY TESTING OF MYCOBACTERIUM TUBERCULOSIS ISOLATES COMPARED WITH THE PROPORTION METHOD ON SOLID MEDIA 1*Chiyoji ABE, 1Akio AONO, and 1Kazue HIRANO 1*Research Institute of Tuberculosis and 2Fukujuji Hospital, Japan Anti-Tuberculosis Association The methods most widely used for susceptibility testing against anti-tuberculosis drug (AST) are the proportion method on Lowenstein-Jensen egg(L-J), Ogawa egg or Middle- brook agar media, and BACTEC TB 460 system. Recently, drug concentrations have been established for AST using the automated BACTEC MGIT 960 system (aMGIT). We have evaluated the BACTEC MGIT 960 SIRE kit for AST of Mycobacterium tuberculosis to isoniazid, rifampin, streptomycin and ethambutol. Also we compared the results with the proportion methods on Middlebrook 7H10 agar (7H10), L-J and Ogawa egg, and the manual MGIT system (mMIGT). Overall concordance rates among aMGIT and the proportion method on 7H10 or Ogawa media were 98.3% and 96.9% for 4 first-line drugs, respectively. Rates were particularly high for isoniazid and rifampin between aMGIT and 7H10 (efficiency of 100%). On the other hand, overall concordance rates among two egg media, L-J and Ogawa were 99.9%. Agreement between aMGIT and mMGIT was high for the AST to isoniazid and rifampin, but lower for the AST to ethambutol (90.9%), which relates to a lower specificity of mMGIT. The mean times to aMGIT and mMGIT results of susceptibility were 7 and 6 days, respectively, contrasted with 3 weeks in 7H10 and 4 weeks in L-J and Ogawa, indicating that both MGIT systems have the potential to consistently meet the turnaround time suggested by Centers for Disease Control and Prevention (CDC) of the United States. These results demon- strate that the fully automated BACTEC MGIT 960 SIRE system for AST is useful for rapid diagnosis of drug resistant tuberculosis. Key words:Drug susceptibility testing, Mycobacterium tuberculosis, BACTEC MGIT 960 system, Proportion method *3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533 Japan. (Received 20 Jun. 2001/Accepted 8 Aug. 2001) <3> Kekkaku Vol.76, No.10:663-666,2001 A CASE OF ISONIAZID-RESISTANT TUBERCULOSIS DIAGNOSED DURING CHEMOPROPHYLAXIS WITH ISONIAZID *Makoto TOYOTA and Shigeharu MORIOKA *Kochi City Health Center A 15-year-old man, who was a classmate with the index case of a large outbreak of tuberculosis in a junior high school in Kochi city, showed strongly positive reaction to tuberculin skin test in March 1999. After taking a chest X-ray film, which showed no abnormal finding, chemoprophylaxis with isoniazid was started in April 1999. He was compliant with therapy, and had no symptom until July 1999, when he was checked again by chest X-ray and abnormal finding was suspected. He visited a hospital for further examinations, and chest X-ray revealed cavitary lesion and sputum smears showed acid-fast baccili. Cultures of the sputum was positive for Mycobacterium tuberculosis, and drug susceptibility tests revealed that the organism was resistant to isoniazid (5ƒÊg/ml) and sensitive to RFP, SM, and EB. RFLP analysis of Mycobacterium tuberculosis isolated from the index-case patient and the present patient demonstrated an identical pattern, although the organism obtained from the index-case patient was sensitive to isoniazid, RFP, SM, and EB. Mycobacterium tuberculosis isolated from other 7 patients in the same outbreak showed an identical pattern in RFLP analysis and were also sensitive to isoniazid. The present patient was a close contact with the highly infectious index-case patients. The patient was estimated to be infected around September to October, 1998, and chemoprophylaxis with isoniazid was started in April 1999, when the tubercle baccili had grown considerably, but not enough to show radiographic abnormality. These two factors might be attributable to rarely seen development of isoniazid resistance in this case. Key words:Tuberculosis outbreak, Chemoprophylaxis, Resistant to isoniazid, RFLP analysis *2-4-1, Marunouchi, Kochi-shi, Kochi 780-0850 Japan. (Received 23 Feb. 2001/Accepted 13 Jun. 2001) <4> Kekkaku Vol.76, No.10:667-672,2001 TWO CASES OF MULTI-DRUG-RESISTANT PULMONARY TUBERCULOSIS WITH PARA-AMINOSALICYLIC ACID (PAS)-INDUCED HYPOTHYROIDISM *Hiroshi MIZUTANI, Michiaki HORIBA, Joh SHINDOH, Tomoki KIMURA, Masami SON, and Keiko WKKAHARA *Department of Respiratory Medicine, Ogaki Municipal Hospital Two cases of multi-drug-resistant pulmonary tuberculosis with para-aminosalicylic acid (PAS)-induced hypothyroidism were reported. Case 1;a 73-year-old male, complaining of edema, was admitted to our hospital. He had been treated for his multi-drug-resistant pulmonary tuberculosis during the past 1 year with an antituberculous regimen consisting of ethambutol (EB), ethionamide (ETH) and PAS. A thyroid profile performed when he was admitted to our hospital showed several marked abnormalities:serum thyroid stimulating hormone (TSH) was elevated (69.4ƒÊIU/ ml:normal, 0.4-4.2mIU/ml), free thyroxine level (T(4))(0.01ng/dl;normal, 0.70-1.60ng/ dl) and free triiodothyronine level (T(3)) (0.60pg/ml;normal, 2.3-4.1 pg/ml) were low. PAS was discontinued after he was admitted to our hospital, since PAS was believed to be the cause of the hypothyroidism. A thyroid profile that was repeated after the exclusion of PAS from treatment showed the following results:the TSH level was decreased (13.4 mIU/ml), the free T4 (0.93ng/dl) were normal. During treatment with PAS, he had never received thyroid replacement therapy. Case 2;A 22-year-old female, complaining of hemosputum. She had been treated for her multi-drug-resistant pulmonary tuberculosis during the past 11 months with an antituberculous regimen consisting of EB, ETH and PAS. A thyroid profile performed when she was admitted to our hospital showed several marked abnormalities:elevated serum TSH (112.7 mIU/ml), and low T(4)(2.0ƒÊg/dl) and T(3)(1.1ng/ml). A thyroid profile that was repeated after the exclusion of PAS from treatment showed the following results:the TSH level was decreased (5.1mIU/ml). Drug-induced hyporhyroidism is an infrequent side effect of therapy with PAS, and only a few cases of PAS-induced hypo- thyroidism have been reported so far. In this report, we describe patients with hypothy- roidism who were receiving therapy for multi-drug-resistant tuberculosis, tuberculosis namely, resistant to at least isoniazid (INH) and rifampicin (RFP), with a regimen that contained PAS. Key words:Para-aminosalicylic acid (PAS), Hypothyroidism, Multi-drug-resistant tuberculosis, Pulmonary tuberculosis *4-86, Minaminokawa-cho, Ogaki-shi, Gifu 503-8502 Japan. (Received 19 Mar. 2001/Accepted 18 Jun. 2001) <5> Kekkaku Vol.76, No.10:673-676,2001 ORCHIECTOMY FOR TUBERCULOUS EPIDIDYMITIS: A REPORT OF TWO CASES WITH INTRACTABLE TO ANTITUBERCULOSIS TREATMENT *Naomi KUNICHIKA, Kazuo MURAKAMI, Kiyoshi MAKIHATA, Kazushi TAKAO, Kenichi CHIKAMORI, Keisuke AOE, Nobuaki MIYAHARA, Tadashi MAEDA, Ryosuke EDA, and Hiroyasu TAKEYAMA *Department of Internal Medicine, National Sanyo Hospital This paper describes two cases with tuberculous epididymitis. The first case was a 69- year-old man who was admitted to our hospital because of ulceration of right scrotum. Physical examination revealed a hard, rounded, a little bigger than egg-sized mass in the right scrotum. The second case was a 40-year-old man who was admitted to our hospital because of cough, fever and body weight loss. He was treated for pulmonary tuberculosis with isoniazid, rifampicin, streptomycin and pyrazinamide. Six months after admission, he complained of a painless swelling of the right scrotum. Physical examination revealed a hard, rounded, more than egg-sized mass in the right scrotum. Right orchiectomy was performed in these two cases, and they were cured. Key words:Tuberculous epididymitis, Extrapulmonary tuberculosis, Pulmonary tuberculosis, Genito-urinary tuberculosis *685, Higashi-Kiwa, Ube-shi, Yamaguchi 755-0241 Japan. (Received 21 Mar. 2001/Accepted 25 Jun. 2001) <6> Kekkaku Vol.76, No.10:677-678,2001 The 76th Annual Meeting Symposium ‡X. STRATEGY OF TUBERCULOSIS CONTROL AND ACHIEVEMENT IN OKINAWA Chairpersons:1*Morio OSHIRO, 2Tadashi NAKASONE 1*Okinawa General Health Service Association, 2Okinawa Prefectural Public Health Center After fierce battles in World War II, Okinawa was occupied by military of U.S.A. and consequently was administrated by USCAR (United States Civil Administration of Ryukyus). During 27 years from April 1945 to May 1972, reversion to Japan, the public Health Activi- ties including T.B. control were performed by Ryukyus Government indirectly controlled by USCAR. The first issue of T.B. statistics was made in 1950. It revealed remarkable reduc- tion of T.B. death rate, a quarter of that before the war. The main reasons of the reduction were considered due to the over-death in battles. But epidemic of T.B. had increased rapidly, especially since the Korean War occurred in 1950. Constructions of the military base were booming, and T.B. infection was spread among laborers, employees, and also their families. Then, Ryukyus Government enacted a temporary law of T.B. prevention and control in 1954. Home-care treatment of T.B. patient was started with registration and management in newly constructed Public Health Centers. Because of shortage of government budget, man-power including doctor and poor institutes, a system of short-termed admission treatment (6 months) and home cared chemotherapy were started. Public Health Nurses (PHN) took care the patient at home, and medical fee of T.B. treatment was free in charge to patients. So activities of PHN were very important. In 1962, Dr. Shoukou Imamura, from JATA, came to study the system of home care treatment. And 7,000 cases under supervision of Public Health Center were investigated. He reported that this system was fairly efficacious in Okinawa. In 1976, after reversion to Japan, study of T.B. surveillance control system was advised and introduced by Dr. Masakazu Aoki and Dr. Tooru Mori (JATA). By this modern system of surveillance, T.B. control is improved progressively in Okinawa. Key words:Temporary law of T.B. prevention and control, Home care treatment, T.B. surveillance control system *212 Haebaru-cho, Okinawa 901-1192 Japan. (Received 16 Jul. 2001)