Biomedical subjects

Hideo Ogata

Publications and source records attributed to Hideo Ogata.

At least 19 recordsLinked to original sources

PubMed2006

[Clinical studies on the pathogenetic factors of cavitary and nodular bronchiectatic types in pulmonary Mycobacterium avium complex disease].

We investigated the clinical, laboratory and radiological findings of 273 newly diagnosed cases of pulmonary Mycobacterium avium complex (MAC) disease, who were diagnosed in our hospital during 7 years from January 1996 to December 2002. Radiological findings of all cases were classified at the time of diagnosis into 2 patterns, the cavitary (Cav) type and the nodular bronchiectasis (NB) type. Clinical and laboratory findings at the time of diagnosis of 44 death cases were compared with those of 273 newly diagnoses cases, to analyze the prognostic factors of this disease. MAC disease cases showed a marked increase in number in recent years, but only in women. Mean age at the first visit was 65.7 years in men and 63.2 years in women, and when limited to fatal cases, it was 72.3 years in men and 69.4 years in women. Low body weight in terms of body mass index (BMI) and moderately low serum albumin level were found at the time of the first hospital visit in all the newly diagnosed and death cases. In the fatal cases, the peripheral blood lymphocyte counts revealed a relatively smaller number than the normal range, and the PPD skin test showed a negative reaction in 57.7% of all cases, suggesting the presence of lowered cell-mediated immunity at the time of diagnosis. Whether malnutrition occurs as a result of MAC disease or the individuals with lower nutrition level are easy to develop to MAC disease remains to be clarified. In regard to radiological findings, many cavitary (Cav) type cases were found in men and nodular bronchiectasis (NB) type in women among newly diagnosed cases, while the cavitary type was observed in many in both men and women fatal cases. The mean duration period from diagnosis to death was 28.3 months in men and 60.2 months in women, showing a longer survival after diagnosis, perhaps due to earlier hospital visits by women. The average age at death was 74.4 years old in men and 73.8 years old in women, and the two radiological patterns did not change throughout the entire disease course.

Aged↗

PubMed2006

[Twice-weekly intermittent chemotherapy during the maintenance phase of the short-course treatment for new patients with pulmonary tuberculosis].

BACKGROUND AND OBJECTIVE: Various types of intermittent chemotherapy regimens have been applied for the treatment of tuberculosis worldwide, but, in Japan, any type of intermittent treatment has not been adopted currently as the standard regimens for the treatment of tuberculosis. Intermittent regimens have a great advantage to facilitate directly observed therapy (DOT). To introduce DOT more extensively in Japan, we conducted the present clinical trial to assess the effectiveness and safety of intermittent chemotherapy. PATIENTS AND METHODS: This is a non-randomized trial to compare twice-weekly intermittent therapy under DOT with daily therapy by self-administration. Newly diagnosed patients with pulmonary tuberculosis who completed the initial intensified phase of 2 months with 4 drugs were enrolled. Supervision of drug administration was carried out by the pharmacists who cooperated to the study (Pharmacy DOT). RESULTS: Total 385 patients were enrolled in this trial, of which 135 patients were treated by twice-weekly intermittent maintenance chemotherapy under the supervision by pharmacists and remaining 250 patients were treated by daily maintenance chemotherapy without supervision (self-administration). Treatment success-rates were 97.6% for intermittent treatment group and 95.6% for daily treatment group. Relapse rates after the completion of the treatment course were 3.73/ 100 person-year and 1.76/100 person-year, respectively. The difference between the two groups was not statistically significant. Adverse events required the modification of treatment schedule occurred only in 0.2% of the intermittently treated patients. CONCLUSIONS: After the successful completion of the initial intensified phase of tuberculosis chemotherapy, twice-weekly intermittent chemotherapy during the maintenance phase under the supervision by pharmacist is as effective and safe as the daily therapy, and is conveniently accepted by the patients. The pharmacy DOT with the intermittent therapy during maintenance phase adopted in this trial, should be widely introduced in Japan.

Adolescent↗

PubMed2006

[Number of sputum cultures by MGIT system needed to diagnose pulmonary tuberculosis].

PURPOSE: To study the number of sputum cultures by MGIT system (Becton-Dickinson) needed to diagnose pulmonary tuberculosis. OBJECT AND METHOD: Prospective study of all patients who visited our hospital, and were strongly suspected of pulmonary tuberculosis during the period from Jan. 2002 to Sept. 2003. In these patients, 3 consecutive sputum cultures were done by both MGIT-system and egg-based Ogawa medium (1 slant). RESULTS: Altogether 290 cases of sputum-culture positive pulmonary tuberculosis were available for analysis. In 210 first-sputum-smear positive cases, incremental yield of 3rd sputum culture in 3 consecutive MGIT cultures was equal to or less than 1.0% and 98.1% of culture positive cases were detected by 2 consecutive MGIT cultures. In 80 first-sputum-smear negative cases, incremental yield of 3rd sputum culture in 3 consecutive MGIT cultures was equal to or more than 5.0%, and 90.0% of culture positive cases were detected by 2 consecutive MGIT cultures. This detection rate was almost the same as the calculated detection rate (91.4%) by 3 consecutive Ogawa (2 slant) cultures (previous standard method). CONCLUSION: It was suggested that 2 consecutive sputum cultures by MGIT were sufficient to detect M. tuberculosis in first-sputum-smear positive cases, but 3 consecutive sputum cultures by MGIT were relatively useful in first-sputum-smear negative cases.

Culture Media↗

PubMed2006

[Bacteriological and pathological analysis on the pathogenetic factors for cavitary and nodular bronchiectatic type of pulmonary Mycobacterium avium-intracellulare complex disease].

A total of 101 strains of Mycobacterium avium complex (MAC), consisting of 86 M. avium and 15 M. intracellulare strains, were examined by DNA sequencing. The frequency of radiological types [cavitary (Cav) type and nodular bronchiectatic (NB) type] was similar in each species, thus, both species are equal causes of the two radiological types of MAC disease. We also examined serovars of the isolated strains using extracted glycopeptidelipid antigens and thin layer chromatography. Cav type patients discharged a single serovar MAC, while NB type patients discharged two serovar MACs simultaneously. RFLP pattern obtained by the use of IS1245, revealed no clustering of the strains specific for Cav type and NB type. Histopathological examinations of the bronchial lesions in 40 MAC cases and 49 multi-drug resistant tuberculosis (MDR-TB) cases were performed on the surgically removed lung specimens. Lymphocytic infiltration, epithelioid cell granuloma formation, epithelial desquamation and ulceration, as well as smooth muscle atrophy as a cause of bronchiolectasis, were observed more often and were more severe in the peripheral bronchial walls of the NB type than the Cav type of MAC, and as compared with those of MDR-TB cases.

Diagnosis, Differential↗

PubMed2005

Clinical evaluation of serodiagnosis of active tuberculosis by multiple-antigen ELISA using lipids from Mycobacterium bovis BCG Tokyo 172.

The humoral immune responses of 69 active tuberculosis (TB) patients against three major mycobacterial lipid antigens, monoacyl phosphatidylinositol dimannoside (Ac-PIM2), trehalose 6,6'-dimycolate (TDM-T) and trehalose 6-monomycolate (TMM-T) from Mycobacterium bovis BCG Tokyo 172, were examined by ELISA. IgG antibodies from active TB patients were reactive against each of the three lipid antigens (Ac-PIM2, TDM-T and TMM-T), giving positive results of 42.0-59.4%. If tests were combined and an overall positive was scored when any of the three tests was positive, sensitivity was 71.0%, showing better discrimination between patients and normal subjects. Although this value is not satisfactory for the clinical diagnosis of active TB, it is still higher than values for Determinar TBGL (56.5%) and MycoDot (31.9%) test results, both of which are commercially available. IgG antibody responses to particular lipid antigens in an individual patient differed diversely between patients. Positive IgG antibody rates and IgG antibody levels to lipid antigens were mostly paralleled by the amount of mycobacteria excreted and by the severity of pathological lesions (size and cavity formation). Serologically positive responsiveness was shown in 60.0% of tuberculin skin test (TST)-negative TB patients. Furthermore, seropositivity for multiple-antigen ELISA in active TB patients was demonstrated in other possible immune-suppressed cases, such as senile, diabetes mellitus and fulminant TB patients. Therefore, in contrast to tests based on cellular immune responses such as the TST, the humoral immune responses of TB patients against mycobacterial lipid antigens were disease-specific and were shown to be useful for the early diagnosis of active TB disease in conjunction with smear and cultivation tests, even if cellular immune responses are decreased.

Adult↗

PubMed2005

[Risk of acquisition of RFP resistance out of INH resistant RFP susceptible tuberculosis].

OBJECTIVE: To investigate the prognosis of isoniazid (H) resistant rifampicin (R) susceptible tuberculosis cases with emphasis on the risk factors of developing MDR. METHOD: Retrospective review of H resistant R susceptible tuberculosis cases that were treated at Fukujuji Hospital in Japan between 1990 and 2000. RESULTS: Four cases developed drug resistance and became MDR. Seventy seven cases completed treatment with bacteriological confirmation of negativity during treatment and 2 years after treatment (cure). Other 38 cases completed treatment with confirmation of culture negativity at the end of treatment but one of them relapsed within 2 years and the remaining 37 cases were not followed up for 2 years. Fourteen cases died, 13 cases defaulted and 17 cases were transferred out. The comparison of the regimen of chemotherapy between cured cases and cases who became MDR showed that more cured cases were found among those who started treatment with 4 drugs or more than cases who started treatment with 3 drugs or less. Other factors that were related (but not significant) to cure rate were non-diabetics in comparison with diabetics and 4 drug standard regimen (HRZS, HRZE) in comparison with 3 drug standard regimen (HRS, HRE). DISCUSSION: Prevention of MDR could be achieved by wider use of 4-drug standard regimen and changes of chemotherapy regimen promptly responding to the results of drug susceptibility tests.

Adult↗

PubMed2005

[Treatment results of multi drug resistant tuberculosis, a hospital based study].

SETTINGS: Fukujuji Hospital, Japan. PURPOSE: To evaluate treatment results of multi drug resistant tuberculosis cases. METHOD: Retrospective review of 100 multi drug resistant tuberculosis cases who started treatment in 1990-1999 at Fukujuji Hospital. Life table analysis and analysis of longterm treatment results were done. RESULT: Observation for more than 3 years after starting treatment revealed cure in 62, chronic excreters in 2, and died cases with positive culture in 10, and treatment completed with shorter observation period in 8. The remaining 18 cases were either transfer-out, defaulted or died with other causes. The older age, cavitary lesions (bilateral>unilateral>no), resistance to more drugs, interruption of treatment due to side effects to second line drugs and the complication of diabetes mellitus were independent risk factors for unfavorable results. The treatment results improved with the increase of the number of effective drugs used for 6 months or more. The surgical intervention improved the proportion of favorable treatment results for those that were culture positive after 5 months of treatment. DISCUSSION: Treatment results of MDR TB was not satisfactory. Diabetics was the risk factor of unfavorable results. The conditions for the indication of surgical intervention among culture negative cases after 5 months of medical treatment needs to be further investigated.

Adult↗

PubMed2005

[Should chemotherapy for pulmonary tuberculosis be started after the completion of pretreatment sputum examination?].

PURPOSE: Investigation on the influence of early start of chemotherapy on the results of sputum smear and culture (Ogawa medium and BACTEC MGIT960). OBJECT AND METHOD: Retrospective study for tubercle bacilli positive pulmonary tuberculosis cases in our hospital. RESULT: Starting chemotherapy before the completion of pretreatment sputum examination was found to have no adverse effect on smear positive rate and smear positive grade (246 cases), culture contamination rate on Ogawa medium and BACTEC MGIT960 (1128 sputums), culture positive rate and culture positive grade/time to confirm positive on Ogawa medium (245 cases), and culture positive rate on BACTEC MGIT960 (239 cases). Time to confirm positive on BACTEC MGIT960 was slightly, but significantly prolonged (1.16 days delay in cases with 1-3 days chemotherapy [228 cases], and 4.01 days delay in cases with 4-6 days chemotherapy [59 cases]). CONCLUSION: Unfluence of early start of chemotherapy on the results of sputum smear and culture is minor. In most of bacilli positive pulmonary tuberculosis cases chemotherapy can be started before the completion of pretreatment sputum examination.

Adolescent↗

PubMed2004

[The results of DOTS strategy].

Tuberculosis control in Japan is now on the stage of program transition since the declaration of emergency of tuberculosis in 1999. The "21st century DOTS, Japan version" has been proposed under the influence of DOTS experiences in the United States, where drastic reduction of tuberculosis was observed after the introduction of universal DOT. We cannot copy the experiences of US, considering the difference of epidemiological situation of tuberculosis, social background of TB cases and the difference of health infrastructure for TB patients. In the United States, many tuberculosis patients are treated under government health system with DOT. In Japan, TB cases are treated at clinics and hospitals under the integrated health system and public health centers mainly provide prevention services including contact examination of TB and cohort analysis of TB cases. 21st century DOTS, Japan version, is not the universal system at present but it is on the process of implementation and various kind of new activities have been tried including activities to assure the close collaboration between public health centers and clinics, and DOT activities including hospital based DOT, ambulatory intermittent DOT at pharmacies. Here are presented with various experiences both in the field of collaboration between public health centers and clinics, and in the field of DOT. Also here are presented with the calculation which shows the reduction of total cost of tuberculosis treatment by the introduction of ambulatory DOT, considering the influence of recurrence of defaulter cases which would have occurred without DOT. We consider that this symposium is the interim report of the expansion of Japanese DOTS.

Adult↗

PubMed2004

[C-reactive protein in patients with bacteriological positive lung tuberculosis].

PURPOSE: To investigate the usefulness of measuring C-reactive protein in the diagnosis of lung tuberculosis. OBJECT: Tuberculosis patients treated by chemotherapy at Fukujuji Hospital from Jan./1/2000 to Dec./31/2001. METHOD: Chart review. RESULTS: CRP are negative in 13.3% (95%CI: 8.9-17.7%) in sputum smear positive lung tuberculosis patients (N = 226), and in 73.0% (95%CI: 62.0-84.0%) of sputum smear negative culture positive lung tuberculosis patients (N = 63). CONCLUSION: Usefulness of measuring C-reactive protein in the diagnosis of bacteriological positive lung tuberculosis is limited.

Bacteriological Techniques↗

PubMed2004

[Multi-drug resistant lung tuberculosis due to double infection of MDR strain].

The case is 47-year-old, homeless man. He was diagnosed as cavitary, sputum smear positive pan-sensitive lung tuberculosis, and admitted to TB ward of our hospital. At the age of 4-year-old he had tuberculous hilar lymphadenopathy and took medicine. He had no other associated disease, and HIV test was negative. He started standard chemotherapy and 2 months later his sputum culture was converted to negative. His adherence to medicine was thought to be good. But about 2 weeks after the sputum conversion, his sputum culture was re-converted to positive for Mycobacterium tuberculosis. Thereafter, during and after the completion of standard chemotherapy, his sputum culture had been intermittently positive. The drug sensitivity tests of the strain after re-conversion showed multi-drug resistance. RFLP analysis revealed that the strain before conversion was totally different strain from the strain after re-conversion to positive. The case was considered to be caused by the double infection of MDR strain of Mycobacterium tuberculosis during the course of treatment for tuberculosis due to a sensitive strain of Mycobacterium tuberculosis.

Antitubercular Agents↗

PubMed2004

[Drug resistance in recurrent cases of tuberculosis].

PURPOSE: Investigate drug resistant rate in recurrent cases after cure, or after drop-out from treatment, and the analysis of the risk factors for acquired drug resistance in these cases. OBJECT: Patients who were previously treated for tuberculosis that was drug sensitive or unknown about previous drug sensitivity, and were hospitalized to Fukujuji Hospital to start treatment for recurrent tuberculosis from Jan. 1, 1993 to Dec. 31, 2003. Primary drug resistant cases were excluded and cases were further divided into full sensitive cases and cases with drug sensitivity test results were unknown. METHOD: Chart review. RESULT: Drug resistant rate (any resistance to INH, RFP, SM, EB) in all recurrent cases (N=200) was 16.5%. Availability of previous drug sensitivity results affected on the drug resistant rate in recurrent cases. In previously pan-sensitive cases, drug resistant rate was 4.3% and it was lower than the rate in primary treated cases. No significant risk factor for acquired drug resistance was not found, including poor adherence to medication. CONCLUSION: Every effort should be made to know the previous drug sensitivity results because these results have a major impact on drug resistance rate at recurrence. Doctor's mismanagements of tuberculosis patients might be the major factor for acquired drug resistance in recurrent cases, and it is needed for the improvement of tuberculosis control program to implement the measures to control these mismanagements.

Adult↗

PubMed2004

[Miss-management in treatment failure of pulmonary tuberculosis].

PURPOSE: To investigate the risk factor of treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from the standpoint of both clinical management and tuberculosis control. OBJECT AND METHOD: Retrospective chart review of patients who admitted to Fukujuji Hospital for treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from Jan. 1993 to Dec. 2003. RESULTS: Out of 24 treatment failure cases available for analysis, 4 cases were associated with chronic tuberculous empyema with broncho-pleural fistula, and among them, chronic empyema was considered to be the main cause of treatment failure in one case. In 6 cases, poor adherence to medication was confirmed or suspected, and 2 of these 6 cases was also associated with miss-management. In 9 cases miss-management was found without poor adherence or chronic empyema, and in 8 out of these 9 cases, miss-management was considered to be the main cause of treatment failure. In 5 cases no apparent risk factor was found, but in 2 out of these 5 cases the ignorance of the results of drug sensitivity tests (and, therefore, miss-management) was strongly suspected. Summing up, in 10 out of 24 cases (41.7%), the miss-management was considered to be the main cause of treatment failure, and it was more frequently seen than poor adherence to medication. CONCLUSION: Clinicians should be aware of these risk factors of treatment failure such as chronic empyema, weak regimen in bacteriological negative cases, rifampicin+ethambutol regimen, and miss-management of drug adverse effect. From the standpoint of tuberculosis control in Japan we considered that, in addition to DOT, strategy to secure the quality of tuberculosis treatment is by all means needed.

Adult↗

PubMed2004

[Are tuberculosis advisory committees well-functioning?].

PURPOSE: To evaluate the function status of TB advisory committee to assess treatments of tuberculosis. OBJECT AND METHOD: Estimate by questionnaire sheets to public health nurses attending to seminars on tuberculosis at Research Institute of Tuberculosis. RESULT: 137 answers are available for analysis. Of these, 57 (41.6%) TB advisory committees are estimated not to assess treatments of tuberculosis at all and/or to assess treatments without necessary informations on drug sensitivity in more than around half of the cases. In 13 (16.3%) committees of the other 80, many cases are in fact self-assessed. Number of committees that are estimated to functioning well is only 44 (32.1%). CONCLUSION: Many TB advisory committees are estimated to be malfunctioning from the stand point of assessments of treatment. As TB advisory committee is one of key agency to control drug-resistant tuberculosis, its reform and revitalization are urgently needed.

Advisory Committees↗

PubMed2004

[Process of acquiring drug resistance: retrospective review of records of MDR TB].

PURPOSE: To investigate the reasons of acquiring drug resistance among MDR TB cases and to learn lessons for the prevention of acquiring of drug resistance. METHOD: Retrospective review of 159 MDR TB cases who were treated at Fukujuji Hospital from 1990 January to 2003 August. RESULT: We found that among 159 cases, 48 cases were infected with multidrug resistant M. tuberculosis bacilli, 35 cases acquired drug resistance, 7 cases were with the history of tuberculosis treatment before 1970 only, and that remaining 69 cases were difficult to evaluate because of the lack of informations on previous drug susceptibility tests. Among 35 cases that acquired drug resistance, the drug susceptibility test patterns before becoming MDR TB were categorized as follows: 12 HR susceptible, 18 H resistant R susceptible, 3 R susceptible (H unknown), and 2 H susceptible R resistant. The factors that may have influenced to acquire MDR were lack of modification of the regimen after knowing drug resistance among H resistant R susceptible cases, and defaulting among cases that were not evaluated (15/69) and H resistant R susceptible cases (3/18). DISCUSSION: Control of MDR TB needs to be strengthened. Proper drug susceptibility test, proper choice of drugs at the beginning of treatment and modification of treatment after knowing drug susceptibility test results are important for the prevention of MDR TB. Ensuring patient adherence to treatment is important in the medical institutions where drug susceptibility test is not properly done, in particular, for H resistant R susceptible cases, and guidance to these institutions by the public health centers should be intensified.

Adult↗

PubMed2003

[A comparative study on severity of tuberculosis cases between those found by periodical chest X-ray examination and those found by symptomatic visit to OPD in Japan].

BACKGROUND: Japanese national tuberculosis control program (NTP) has included indiscriminate chest X-ray examination for adult population. METHODS: A comparative study on the severity of pulmonary tuberculosis cases in a hospital in Tokyo by the mode of detection (between cases found by periodical check and cases found by symptomatic visit) and previous history of X-ray examination (among cases detected by periodical check, cases detected by symptomatic visit but with previous history of periodical check and cases without history of chest X-ray examination during the past 3 years). RESULTS: The comparison between patients found by symptomatic visit with and without previous history of periodical check showed that there was no difference in the grade of sputum smear positivity at the time of diagnosis but that those without previous history of periodical check were more serious as to chest X-ray findings. The comparison between patients found by symptomatic visit with previous history of periodical check and those detected by the periodical check showed that the grade of smear positivity was less among those found by the periodical check but no difference as to chest X-ray findings, however, comparing cases of these two categories in the age group of 40-59, those detected by the periodical check were less serious as to both X-ray findings and smear result. There were 21 persons who were indicated requiring further investigation but actually were not examined. The severity of tuberculosis among these 21 persons were more serious as to the grade of smear positivity than those detected by periodical X-ray examination.

Adult↗

PubMed2003

[Activity of cephems and carbapenems against clinically isolated Mycobacterium abscessus].

To screen effective useful drugs for disease due to M. abscessus, we determined MIC of 3 cephems [ceftazidime (CAZ), cefoxitin (CFX), flomoxef (FMOX)] and 3 carbapenems [imipenem (IPM), panipenem (PAPM), meropenem (MEPM)] for 8 strains of clinically isolated M. abscessus by micro-dilution method using MGIT system. In all the 8 strains, MICs of CAZ are higher than 32 micrograms/ml. MIC50, MIC90, MIC range of CFX are 32 micrograms/ml, > 32 micrograms/ml and 16- > 32 micrograms/ml respectively, and for FMOX, 16 micrograms/ml, 32 micrograms/ml and 16-32 micrograms/ml; for IPM, 8 micrograms/ml, 16 micrograms/ml and 8-16 micrograms/ml; for PAPM, 4 micrograms/ml, 16 micrograms/ml and 4-16 micrograms/ml; for MEPM, 8 micrograms/ml, 16 micrograms/ml and 8-16 micrograms/ml. From this study, it is concluded that FMOX, IPM, PAPM and MEPM can be clinically useful drugs in the treatment of the disease due to M. abscessus.

Carbapenems↗

PubMed2002

[Pulmonary Mycobacterium avium complex (MAC) disease showing middle lobe syndrome--pathological findings of 2 cases suggesting different mode of development].

Two different processes have been proposed for pathogenesis of Mycobacterium avium complex (MAC) disease which show the middle lobe syndrome: 1) middle lobe bronchiectasis followed by MAC infection and 2) MAC disease resulted in secondary bronchiectasis. Two surgical specimen from MAC cases showing middle lobe syndrome were studied histo-pathologically. The first case was a 60 year-old female with frequent bloody sputum, who had been diagnosed as bronchiectasis in her childhood. Pathological examination of the resected middle lobe showed prominent cylindric bronchiectasis in the indurated middle lobe, and epithelioid cell granulomas were scattered limited to the fibrous bronchial walls, without any granulomas in the lung parenchyma. These findings suggested a secondary infection of MAC to the non-specific pre-existed bronchiectasis. The second case of a 55 year-old female having repeated bloody sputum, who was diagnosed to be tuberculosis but no improvement with anti-tuberculosis drugs. Pathological examination of the middle lobe showed scattered epithelioid cell granulomas with lymphocytic infiltration in the lung parenchyma. A few epithelioid cell granulomas were also found in the mucosa of middle lobe bronchi. In this case, pulmonary MAC lesions seemed to precede the central bronchial lesion with later development of bronchiectasis. Summarizing above findings two different mode of pathogenesis ways may be considered; one is non-specific bronchiectasis followed by middle lobe MAC disease and the other is pulmonary MAC lesion in the middle lobe as a primary change.

Bronchiectasis↗