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PubMed1991

A study of different parameters of cell-mediated immunity in patients with active and chronic tuberculosis.

A study was carried out on cell-mediated immunity in healthy persons and patients with tuberculosis in order to extend the diagnostic capacity in tuberculosis. We studied the relation between baciloscopy and the state of specific cell-mediated immunity in vivo (Mantoux) and in vitro (leukocyte migration inhibition assay with PPD-RT 23 to evaluate specific cell-mediated immunity and PHA to evaluate nonspecific immunity) in 131 patients with active tuberculosis, in 63 patients with chronic tuberculosis, in 62 healthy persons and 10 individuals living with tuberculosis patients. The results demonstrate that the percentage of reaction was very low in both tests, being of no statistical significance the difference between patients with active or with chronic tuberculosis, although it was significant in the control group. In about half of the patients with active tuberculosis a positive baciloscopy could be observed; the percentage was much lower in patients suffering from chronic tuberculosis, the difference between the two groups significant from a statistical point of view. At the same time when we carried out an evolutionary study in 10 patients with positive baciloscopy, we observed a slight capacity of conversion of immunity when the baciloscopy was negative.

Adolescent↗
PubMed2005

[Tuberculosis and its control--lessons from the past and future prospect].

Koch R reported the discovery of tubercle bacilli on March 24, 1882, and the numbers of death from phthisis were collected in the vital statistics from the latter half of 1883 in Japan. Tuberculosis death was officially adopted in the Japanese vital statistics from 1899, and there was certain disagreement existed between the numbers of death from TB and phthisis in 1899, the analysis on the trend of TB in Japan was done based on TB death. Trend of TB in Japan in the past 100 years could be divided into five phases. In phase 1 (1899-1918), TB mortality had increased with the first industrialization of Japan with main focus on the weaving industry. During this period, TB mortality of female was higher than that of male and then major victims of TB were young girls born from 1890 to 1925. In phase 2 (1918-1930), TB mortality decreased through excess death of TB cases by the influenza pandemic in 1918. This decline due to influenza pandemic was seen all over the world, and in the European countries and the U.S., the decline continued up to 1945 while in Japan, TB had increased again in the phase 3 (1930-1945) mainly due to second industrialization with main focus on heavy industry and the impact of quasi-war and war conditions. In phase 4 (1945-mid 1970s), TB started to decline fast due to the excess death of TB cases during the World War II and then, the application of modern TB control started from early 1950s. In phase 5 (from mid 1970s until now), decline of TB has showed down. Increase or slowdown of TB decline was seen nearly all countries of the world, however, its causes were different from country to country. In case of Japan, slowdown was caused by the rapid ageing of the population, in developing countries mainly by the impact of HIV epidemic and in industrialized countries, mainly by the migration of the population and partly by the HIV epidemic. Contribution of phthisiology in Japan to the global progress of phthisiology could be summarized as follows: elucidation of the pathogenesis of TB when TB was highly prevalent in Japan by high incidence of TB from primarily infected youth, the development of mass screening for TB using radiophotography technique developed in Japan, completion of the interpretation method of chest X-ray findings, first success in the mass production of freeze-dried BCG vaccine in the world, the first implementation of the TB prevalence survey using random sampling method in 1953, and the development of a new drug for TB, kanamycin. Phthisiology also contributed to the progress of international health. As the objective index to measure the magnitude of TB problem, the concept of annual risk of TB infection (ARTI) was introduced by Sutherland and Styblo, and by using ARTI, the epidemiological situation of TB could be divided into 3 categories; high prevalence country with ARTI above 1%, low prevalence country below 0.05-0.1%, and middle prevalence country inbetween. To reduce the burden of TB in high prevalence countries, so-called DOTS strategy of TB control was introduced and has been applied in most developing countries, and the gap between high and low prevalence countries has reduced in the past decade. Cooperation in global TB control has also been done actively from the government and NGOs of industrialized countries under the strong leadership of WHO. For the success of TB control, the transmission of tubercle bacilli in a community should be cut either infection, onset of TB or the progress of TB. Prevention of TB infection could be achieved by the early detection of TB cases and their cure by the treatment. To encourage early visit to doctors for those with symptoms suggesting TB and adequate examinations at medical institutions for these persons would be a major tool of early detection of TB cases in Japan in the future. In addition, there is no doubt to intensify contacts examinations and source investigations. It is hoped to elucidate recent pathogenesis of TB by applying new technologies such as QFT and RFLP. Prevention of onset of TB will be focused on the preventive use of TB drugs, however, development of new vaccine better than BCG is also encouraged for the developing countries where the risk of TB infection is remained high. TB is now a curable disease, and the duration of treatment has been shortened to 6 months. If new more potent TB drugs were developed, and the total duration of treatment could be shortened, the global TB control could be done much more easily, and also most MDRTB cases could be cured. Otsuka Pharmaceutical Company is now developing a new potent drug which has no cross resistance with existing TB drugs. This new drug is now on the clinical trial phase II, and it is hoped that Japan can make another great contribution to the global TB control. It is my sincere wish that the government continues to assist the research to develop new TB drugs and new technologies used in TB control, and in future, if it is needed to change the current policy of TB control, a new policy should be tried in a pilot area before its introduction on national level. The Japanese Society for TB is a key organization in developing further research and the training of new personnel engaging in TB research and control, and I sincerely hope further development of the Society.

Adolescent↗
PubMed1996

[From the aspects of complicated diseases].

Pulmonary tuberculosis is one of the most prevalent infectious diseases in Japan. Host defense mechanisms may play an important role in every aspect of the disease, for example in acquiring the disease and/or in progression of the clinical course. Host defense mechanisms are constituted from mechanical protection such as cough or sneeze, chemical resistance such as complements or lactoferrin, nonspecific cellular defense such as macrophages or neutrophiles and specific immunological defense mechanisms such as immunoglobulins or immunocompetent cells. If there were any complicated disease other than pulmonary tuberculosis, the disease outcome might become different. We examined 44 patients whose sputa culture was continuously positive for one year or more, despite of administration of anti-tuberculous regimens. And we also analyzed clinical outcome of 556 patients with pulmonary tuberculosis (control group) who were discharged after bacteriological negative conversion. Diabetes mellitus is one of the most common complications in patients with pulmonary tuberculosis, 11/44 in continuously positive patients and 101/580 in control group. There was no statistical significance between these two. Next, the control group was divided into four subgroups, those were 1. no complication, 2. complicated with diabetes mellitus, 3. complicated with liver dysfunction, 4. complicated with the other diseases. Bacteriological negative conversion rate was analyzed in these four subgroups. At the first and the second month, there were significant difference in negative conversion rate between subgroup 1 and 2. But these differences disappeared as the time goes by.

Adult↗
PubMed1987

[Association of mutant alleles of serum cholinesterase with various multi-factorial and infectious diseases].

Polymorphism of serum cholinesterase (SCE, acylcholinacylhydrolase, EC 3.1.1.8) for the E1 locus was studied in the groups of the patients affected with schizophrenia, peptic ulcer, hereditary erythrocytopathies, tuberculosis, thyreotoxicosis, essential hypertension and rheumatic disease. Increased frequencies of I phenotypes (E1uE1a genotype) were found among patients with peptic ulcer (12.3%), hereditary erythrocytopathies (23.2%), and UF phenotypes (E1uE1f genotype) were observed among patients with schizophrenia (2.8%) and tuberculosis (5.4%). The increased frequencies of E1a and E1f alleles in these groups of patients were, as compared to the control group, statistically significant. The value of relative risk for peptic ulcer was 3.39 in individuals of the E1uE1a genotype, those being 3.62 for schizophrenia and 6.92 for tuberculosis in individuals of the E1uE1f genotype. The nature of the other associations is discussed.

Alleles↗
PubMed2003

Improved tests for a random effects meta-regression with a single covariate.

The explanation of heterogeneity plays an important role in meta-analysis. The random effects meta-regression model allows the inclusion of trial-specific covariates which may explain a part of the heterogeneity. We examine the commonly used tests on the parameters in the random effects meta-regression with one covariate and propose some new test statistics based on an improved estimator of the variance of the parameter estimates. The approximation of the distribution of the newly proposed tests is based on some theoretical considerations. Moreover, the newly proposed tests can easily be extended to the case of more than one covariate. In a simulation study, we compare the tests with regard to their actual significance level and we consider the log relative risk as the parameter of interest. Our simulation study reflects the meta-analysis of the efficacy of a vaccine for the prevention of tuberculosis originally discussed in Berkey et al. The simulation study shows that the newly proposed tests are superior to the commonly used test in holding the nominal significance level.

Analysis of Variance↗
PubMedDate not supplied

[Can the Mantoux test be used in BCG vaccinated children?].

This prospective trial was realized in 371 children previously vaccinated with BCG in the first month of life in whom the Mantoux tuberculin test was done and read 48-72 hours afterwards. Among 371 BCG-vaccinated children, 106 (28.57%) were Mantoux reactive, 10 of whom with clinical tuberculosis. There was no statistically significant difference in the tuberculin test between the control group (59 non-BCG-vaccinated children) and 180 vaccinated children, considering those under 6 years old. When we compared by age, we verified that just 36.36% of the children at the age 2 reacted positively to PPD.

English Abstract↗
PubMed2002

Further investigations on the association of Mycobacterium tuberculosis with Eales' disease.

PURPOSE: To apply polymerase chain reaction (PCR) on vitreous fluid (VF) from Eales' disease to further confirm its association with Mycobacterium tuberculosis. METHODS: Sixty nine VF samples from 69 patients (24 Eales' disease and 45 Non-Eales' as controls) were processed by conventional methods for detection of mycobacteria. Polymerase chain reaction (PCR) specific for IS 6110 and nested PCR (nPCR) using primers coding for MPB 64 gene were applied on all 69 VF. PCR based dot-blot hybridisation was applied on the IS 6110 amplified products of n PCR-positive VFs. RESULTS: Conventional methods (direct smear and culture) did not detect mycobacteria in any of the 69 VF samples. Five (20.8%) of 24 VF from Eales' and 2 (4.2%) of 45 VF from control patients tested positive for M. tuberculosis DNA by nPCR. This difference was statistically significant (P < 0.05). All 69 VF were negative by PCR for IS 6110. Two VF of Eales' patients positive by nPCR were also positive by DNA probe dot-blot hybridisation for IS 6110. CONCLUSION: Detection of M. tuberculosis DNA by PCR in a significant number of VF of Eales' disease patients reemphasizes the association of this bacterium with Eales' disease.

Bacterial Proteins↗
PubMed1992

Vaccination coverage before and after primary health care implementation and trend of target diseases in Al Hassa, Saudi Arabia.

There were two objectives of this study. The first was to determine the impact of vaccination coverage in the first year of life on the trend of the expanded program of immunization (EPI) target diseases in Al Hassa. The second was to determine the impact of primary health care (PHC) implementation in Al Hassa on vaccination coverage. A correlation matrex was computed for all the variables to determine the correlation between vaccination coverage by type of vaccine and reported cases of EPI target diseases. A negative correlation was noticed between Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV), Diphtheria, Pertussis and Tetanus (DPT) and measles vaccine and reported cases of corresponding diseases. This negative correlation was significant (P = 0.043) between measles vaccine and reported measles cases. The average vaccination coverage in the first year of life based on the total number of births significantly increased in 1988 and 1989 compared to the preceding four years (P < 0.01). It is concluded that with increased vaccination coverage in the first year of life against EPI target diseases, the number of reported corresponding diseases decreased, and that PHC implementation improved the vaccination coverage in Al Hassa.

Communicable Diseases↗
PubMed1995

[Role of serum adenosine deaminase as an immune parameter of tuberculosis].

We measured serum levels of adenosine-deaminase (ADA) in 44 tuberculosis patients, 70 patients with lung cancer pre treatment, and 130 normal blood donors. Increased ADA levels were found in 64.4% of the tuberculosis patients, in 95.2% in the case of bacillary tuberculosis, but only in 2.8% in the tumor patients. ADA serum levels were statistically significantly increased in tuberculosis patients when compared to lung cancer patients and controls and did not differ between controls and the tumor group. We conclude that serum ADA is a selective marker of immune stimulation in tuberculosis but not in lung cancer. Serum levels positively correlated to the disease extent in tuberculosis of immunocompetent patients. This marker deserves further investigation with respect to its clinical significance.

Adenosine Deaminase↗
PubMedDate not supplied

[Tuberculosis among indigenous populations in Rondonia, Amazonia, Brazil].

Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records in the Rondonia State Tuberculosis Control Program, identifying the disease's profile among indigenous groups, which are socially more vulnerable and have different issues involved in controlling the disease. The study includes a descriptive statistical and multivariate multinomial analysis of cases reported in 1992 and from 1994 to 1998, attempting to identify factors associated with tuberculosis-related deaths, treatment drop-out, and missing data. Associations were identified between variables related to the disease, to the health service, and to treatment results. There is evidence that the indigenous populations in Rondonia have an increased risk of acquiring and dying from tuberculosis as compared to other residents of the State. Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

Adolescent↗
PubMed2005

Clinical and epidemiological aspects of smoking and tuberculosis: a study of 13,038 cases.

SETTING AND OBJECTIVE: Smoking habit and tuberculosis (TB) appear to have common epidemiological and clinical links. The present study was to evaluate risk factors in TB patients with and without a smoking habit. DESIGN: A cross-sectional observational study of cases (TB with smoking) and controls (TB without smoking) from the same registry. Data were retrieved from case notes and interviews of patients registered in the Tuberculosis Control Programme in Cataluuña, Spain, between 1 January 1996 and 31 December 2002. Statistical analyses included univariate and stepwise multiple logistic regression analyses. RESULTS: There were 13,038 recorded patients. Social factors associated with TB in smokers were male sex (adjusted odds ratio [aOR] 2.2), age <64 years, alcohol use >30 g/day (aOR 7.4) and intravenous drug use (aOR 1.5). Smokers developed more pulmonary disease (aOR 1.5) and more cavitary lesions (aOR 1.9), and were more likely to require hospitalisation (aOR 1.8) which was more protracted. Differences in mortality and delay in diagnosis did not reach statistical significance. CONCLUSIONS: Smoking leads to faster and more severe progression of TB. The cost of TB-related hospitalisation for smokers increases by approximately one million euros per year.

Adolescent↗