4 5

Evaluation of M.kansasii / T. Inoue et al.

Abstract　[Materials and Methods] We retrospectively eval-uated 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)

－－－－－－－－ 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

435

10 11

Isolation of M.shinshuense/Y.Kazumi et al. 441

Abstract　[Purpose] Second clinical infection case of Myco-bacterium shinshuense was presented, we tried the identifi-cation 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 woman.　[Method] Identification by DNA-DNA Hybridization, 16SrRNA and rpoB method as genomic level and conventional method.　[Result] It did not grow on 1％ Ogawa’s slant medium at both 37。C and 42。C, but grew at 28。C. It formed yellowish colonies in the dark. It was difficult to distinguish M.shinshu-ense from M.ulcerans and M.marinum by DNA-DNA hybrid-ization (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 28。C, 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, 3Pathology Center, JA Niigata-ken Kouseiren

Correspondence to : Yuko Kazumi, TB Information Division (Molecular Epidemiology & Genetic Identification), Myco-bacterium Reference Center, Research Institute of Tuberculo-sis, JATA, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533Japan. (E-mail : kazumi＠jata.or.jp)

－－－－－－－－ 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

18

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-02TM, Roken type that counts particles more than 0.7μm in diameter. Based on counting the number of particles more than 0.7μm 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 instruc-tion 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 choice 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-02TM, 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 Infec-tion 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 Orga-nization Tokyo National Hospital, 2Division of Food and Nutrition, School of Human Life Science, Jumonji University

Correspondence to : Yoshiko Kawabe, Department of Respira-tory Disease, National Hospital Organization Tokyo National Hospital, 3_1_1, Takeoka, Kiyose-shi, Tokyo 204_8585 Japan.（E-mail : kawabe＠tokyo.hosp.go.jp）

－－－－－－－－ 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

結核 第79巻 第 7号 2004年 7月448

4） 阿部帥男, 菊池　信, 木村菊二：マスクフィットテス

ターによる密着性の評価. 呼吸保護. 1991 ; 17 : 24_27.5） 成瀬雄一, 塚島英明, 名古屋俊士：マスクフィッティ

ングテスターの実用性に関する研究. 産衛誌. 1995 ; 37 : 177_185.

6） Willele K, Qia Y : Tuberculosis control through respirator

wear : Performance of National Institute for Occupational Safety and Health-regulated respirators. Am J Infect Con-trol. 1998 ; 26 : 139_142.

7） Coffey CC, Lawrence RB, Zhuang Z, et al. : Comparison of

Five Methods for Fit-Testing for N95 Filtering Facepiece Respirators. Appl Occup Environ Hyg. 2002 ; 17 : 723_730.

8） Janssen L, Luinenburg MD, Mullins HE, et al. : Evaluation

of a Quantitative Fit Testing Method for N95 Filtering Face-piece Respirators. Am Ind Hyg Assoc J. 2003 ; 64 : 480_486.

9） US Department of Health and Human Services, Public

Health Service, Centers for Disease Control and Prevention :Guidelines for Preventing the Transmission of Mycobacte-rium tuberculosis in Health-Care Facilities. MMWR. 1994 ; 43 (RR-13) : 1_132.

10） Bailey AE : Effects of Female Facial Dimensions on Full

Face Respirator Fit.（村岡隆光訳）. 呼吸保護. 2001 ; 15 : 30_35.

11） Stricof RL, Delles LP, Diferdinando Jr. G : Mask/particulate

respirator (Mask/PR) use by employees at risk for exposure to multidrug resistant tuberculosis. Am J Respir Crit Care Med. 1994 ; 149 (suppl) : A855.

12） Sutton PM, Nicas M, Harrison RJ : Tuberculosis Isolation :

Comparison of Written Procedures and Actual Practices in Three California Hospitals. Infect Control Hosp Epidemiol. 2000 ; 21 : 28_32.

21

A Case of Pseudo-Recurrence/ K. Ito 451

過観察可能（ないし培養陰性確認後に化学療法中止可能）

であるかどうかは今後の症例の集積を待つほかない。し

かし本症例は，再発診断は原則論として培養陽性をもっ

て golden standardとするべきであるという一般的見解を

強調する 1例ではあろう。また上述のように再発の診断

基準にかなりのばらつきがあるだろうという推測もあ

り4)，今後再発の診断基準を提示する必要があると思わ

れるが，本症例はそうした再発の診断基準を今後考えて

いくうえでも示唆に富む 1例と考える。

文　　　献

1） 工藤祐是：喀痰における抗酸菌塗抹陽性培養陰性. 結核. 1981 ; 56 : 291_299.

2） 馬場　真：結核菌の塗抹培養同時検査により出現する塗抹陽性培養陰性現象の検討補遺｜その5 . 日胸.1966 ; 25 : 247_251.

3） Stead WW: Recurrent Tuberculosis Due to Exogenous Re-infection. New Eng J Med. 2000 ; 342 : 1050.

4） 大森正子：「統計から考える結核問題1999」, 結核予防会, 2000, 32_35.

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 clini-cal 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)

－－－－－－－－ Case Report－－－－－－－－

PSEUDO-RECURRENCE OF LUNG TUBERCULOSIS BASED ON THE DETECTION OF SMEAR AFB POSITIVE SPUTUM

DUE TO EXCRETION OF NECROTIC MATERIAL

Kunihiko ITO

26 27

12） Rezai AR, Lee M, Cooper PR: Modern management of spine tuberculosis. Neurosurg. 1995 : 36 : 87_97.

13） 斉藤正史：脊椎カリエスの治療. MB Orthop. 1996 ; 9 : 59_68.

14） Moon MS : Tuberculosis of the spine. Controversies and a new challenge. Spine. 1997 ; 22 : 1791_1797.

15） Medical Research Council Working Party on Tuberculosis of the Spine : A 15-year assessment of controlled trials of

management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg. 1998 ; 80 : 456_462.

16） American Thoracic Society : Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children. Am J Respir Crit Care Med. 1994 ; 149 : 1359_1374.

457A Case of Multiple Extrapulmonary Tuberculosis/Y. Iwata et al.

Abstract　A 61-year-old woman with schizophrenia that had been treated in a psychiatric hospital was admitted to our hos-pital 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, tubercu-lous 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 im-proved 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 Inter-medicine, National Omuta Hospital, 1044_1, Tachibana, Omuta-shi, Fukuoka 837_0911 Japan. (E-mail : renkei＠oomuta.hosp.jo.jp)

－－－－－－－－ 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