• Clinical and Experimental Pediatrics
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• 제50권11호
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• pp.1134-1138
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• 2007

최근 결핵 유병률이 청소년기에 다시 증가하고 있으며, 이 시기의 결핵은 성인이나 어린 소아와는 다른 임상적 특징을 가지고 있다. 결핵 감염에서 질병으로 쉽게 발전되거나, 폐외 결핵의 발생 빈도가 높고, 폐결핵에서 공동이 잘 생기며, 항결핵제에 내성이 있는 경우가 많아 치료실패율이 높기 때문에 조기 진단과 치료를 위해 의료진의 보다 적극적인 관심과 노력이 필요하다. 저자들은 최근 청소년에서 조직검사로 확진된 폐 및 폐외 결핵 3례를 경험하였기에 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제78권1호
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• pp.1-7
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• 2015

Background: The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting. Methods: Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response. Results: Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%. Conclusion: Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.

• Tuberculosis and Respiratory Diseases
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• 제59권2호
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• pp.179-185
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• 2005

배 경 : 다제내성 폐결핵환자에서 폐병소의 근치절제술 후 일차 항결핵제로 구성된 처방으로 치료하였을 때의 성적을 알아보고자 하였다. 방 법 : 전향적 연구로 국립마산결핵병원에서 1998년 2월부터 2004년 12월 사이에 다제내성 폐결핵으로 수술전 HRCT에서 공동을 포함하는 국소적 병소인 것과 수술 중에 절제부위 이외에 잔존병소가 없다고 판단 된 환자 17명에게 수술 후 3HERZS/3HERS/6HER로 투약하고 그 임상적 경과를 살펴보았다. 결 과 : 대상환자들은 약제감수성검사에서 INH, RFP이외에 평균 4가지 항결핵제에 내성을 보였으며, 술 후 균음전은 평균 2일째 이루어졌다. 평균 39개월의 추구관찰 기간 동안 치료를 중단한 1명을 제외한 94%(15/16) 환자에서 치유되었으며 균음전에 실패한 1명과 치료종결하고 약 7년 후에 재발된 1명은 본원의 처방지침에 따라 이차 항결핵제로 처방을 변경 투약하여 모두 균음전에 성공하였다. 결 론 : 국소적 병변을 가진 다제내성결핵 환자에서 병소의 근치절제후 일차 항결핵제로 구성된 처방으로도 양호한 치료성적을 얻을 수 있었다. 하지만 이러한 경험을 일반화하기 위해서는 더 많은 경험과 병소별 결핵균 주의 특성에 관한 연구 등이 필요할 것으로 사료된다.

• 한국산업보건학회지
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• 제30권1호
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• pp.67-74
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• 2020

Objectives: Previous study has shown that the positive rate of latent tuberculosis infection(LTBI) among former workers in dusty environments was higher than that among high-risk groups of tuberculosis(TB). The objective of the present study was to identify the development of active TB among former workers in dusty environments diagnosed with LTBI. Methods: Between January 2015 and May 2017, 796 former workers in dusty environments who had been subjects of epidemiology research for work-related chronic obstructive pulmonary disease(COPD) had received the QuantiFERON-TB® Gold In-Tube(QFT-GIT) from the Institute of Occupation and Environment(IOE) under the Korea Workers' Compensation and Welfare Service(KCOMWEL). Among them, 437 participants who received a health examination for work-related pneumoconiosis between January 2015 and December 2018 were selected as study subjects. Active TB was defined as a positive result for active PTB and non-tuberculosis mycobacteria infection in the result of the Pneumoconiosis Examination Council's assessment by KCOMWEL. Results: A total of 437 subjects were followed up for 2.1 years. Four of them(4/437, 0.9%) developed active TB during the follow-up period. The attack rate of active TB among subjects who were diagnosed LTBI positive and those who were diagnosed LTBI negative were 0.9%(3/320) and 0.9%(1/115), respectively. Conclusions: Most previous studies reported that the attack rate of the development of active TB in subjects who had been diagnosed LTBI positive was higher than that among subjects who had been diagnosed LTBI negative. To the contrary, the present study found that the rate of developing active TB among former workers in dusty environments diagnosed as LTBI positive was not higher than that in those who were diagnosed LTBI negative.

• Tuberculosis and Respiratory Diseases
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• 제41권1호
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• pp.11-19
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• 1994

연구배경 : 결핵균은 facultative intracellular pathogen으로 대식세포에서 생존 번식할 수 있으며, 결핵균이 체내에서 제거되려면 대식세포와 T 임파구에 의한 효과적인 세포매개성 면역반응이 필요하다. 폐포대식세포에 의한 결핵균 살균은 크게 산소의존성 과정과 산소비의존성 과정으로 구분되는데 산소의존성과정은 NADPH oxidase에 의해 산소가 환원반응으로 과산화음이온을 생성하는 과정으로 시작된다. 저자들은 폐결핵환자의 경우 폐포대식세포의 산소유리기 생성의 이상으로 결핵균이 세포내 오래 생존 번식할 것으로 추정하여 폐결핵환자와 대조군에서 폐포대식세포와 말초혈액 단구세포를 분리하여 분비되는 과산화음이온의 양을 비교하여 보았다. 방법 : 대조군과 폐결핵환자에서 폐포대식세포와 말초혈액내 단구세포를 분리하여 기저상태 및 PMA로 자극한 후 분비되는 과산화음이온의 양을 ferricytochrome-C를 환원시켜 나타나는 발색반응을 이용하여 측정하였고, 단구세포의 경우 결핵환자의 혈청에 의해 어떤 변화를 보이는지 관찰하였다. 결과 : 1) 폐포대식세포에서 분비하는 과산화음이온은 폐결핵환자군와 대조군 사이에 차이가 없었고, PMA로 자극을 했을 때도 두군 사이에 차이가 없이 모두 유의한 증가를 보였다. 2) 말초혈액 단구세포에서 분비하는 과산화음이온은 폐결핵환자군과 대조군 사이에 차이가 없었지만, PMA로 자극을 했을 때 두군에서 모두 유의한 증가를 보였고 폐결핵환자군이 대조군에 비해 높았다. 한편 결핵환자 혈청으로 폐결핵환자군과 대조군의 말초혈액 단구세포를 자극했을 때도 두군에서 모두 유의하게 증가되었다. 결론 : 폐포대식세포와 말초혈액 단구세포에서 분비하는 과산화음이온의 양은 정상인과 폐결핵환자에서 차이가 없었다. 따라서 폐포대식세포에서의 과산화음이온 분비가 부족하여 결핵균이 폐포대식세포내에서 장기간 생존하는 것으로 생각되지 않으며, 오히려 결핵환자의 혈청내에는 말초혈액 단핵구의 과산화음이온 분비를 자극하는 물질이 있을 것으로 생각되나, 정상인 혈청이 과산화음이온 생성에 미치는 효과에 대한 비교 연구가 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제76권4호
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• pp.163-168
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• 2014

Background: Mycobacterial identification in active pulmonary tuberculosis (APTB) is confirmative, even though successful rates using self-expectorated sputum are limited. Sputum specimens collected by hypertonic saline nebulization showed higher bacteriologic diagnostic sensitivities over those of self-expectoration, mostly studied in smear-negative or sputum-scarce patients. The efficacy of induced sputum was rarely assessed in real clinical settings. Methods: A prospective randomized case-control study was performed in one hospital. The subjects highly suspicious of APTB were asked to provide 3 pairs of sputum specimens in 3 consecutive days. The first pairs of the specimens were obtained either by self-expectoration (ES) from the next day of the visit or sputum induction with 7% saline nebulization in clinic (SI), and the other specimens were collected in the same way. The samples were tested in microscopy, culture, and polymerase chain reaction (PCR). The outcomes of the bacteriological diagnosis were compared. Results: Seventy six patients were assigned to either ES (38 subjects, median age of 51, 65.8% male) or SI (38 subjects, median age of 55, 52.6% male). APTB was clinically confirmed in 51 patients (70.8%), 27 in ES and 24 in SI. Among the APTB, more adequate specimens were collected from SI (41/65, 63.1%) than ES (34/80, 42.5%) (p=0.01). Bacteriological confirmation was achieved in 14 (58.3%) patients in SI, and 13 (48.1%) in ES (p=0.46). In the same-day bacteriological diagnosis with microscopy and PCR, there were positive results for 9 patients (37.5%) in SI and 7 patients (25.9%) in ES (p=0.37). Conclusion: Sputum induction improves sputum specimen adequacy. It may be useful for the same-day bacteriological diagnosis with microscopic examination and PCR.

• 대한핵의학회지
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• 제34권2호
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• pp.129-134
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• 2000

목적: 흉부방사선 사진으로 결핵의 진단과 활동성의 판정이 어려운 경우가 많다. 이에 핵의학적 방법으로 결핵의 활동성을 판정하고자 하는 시도들이 있었으며, 핵의학 검사는 결핵의 활동성을 잘 반영하는 것으로 알려져 왔다. 그러나 객담결핵균의 음전을 '활동성'의 소실이라고 표현하는 치료자와 방사능섭취 소실을 '활동성'의 소실이라고 판정하는 핵의학의사 사이에는 용어 사용상의 차이가 있을 수 있다. 객담결핵균의 음전과 방사능섭취의 소실이 서로 일치하는지 여부를 확인하여 보고자 하였다. 대상 및 방법: 세균학적으로 활동성 결핵으로 진단된 15명의 환자들에서 $^{99m}Tc$-MIBI를 이용하여 폐스캔을 시행하였다. 3-7개월간의 항결핵약물치료로 객담 결핵균이 음전된 6명의 환자에 대해 $^{99m}Tc$-MIBI 스캔을 다시 시행하였다. 결핵병소와 정상 폐 부위의 방사능을 측정하여 정상 폐에 대한 결핵병소의 방사능 섭취율을 비교하였다. 결과: 활동성 폐결핵 환자 15명 중 12명(80%)에서 $^{99m}Tc$-MIBI 스캔 양성을 보였다. 항결핵약물치료로 객담 결핵균이 음전된 후 6명에서 $^{99m}Tc$-MIBI 스캔을 반복했을 때 6명 모두에서 섭취율이 치료 전에 비해서 감소하는 경향을 보였다. 그러나 5명에서는 정상 폐에 비해서는 여전히 높았다. 결론: $^{99m}Tc$-MIBI 스캔은 폐결핵 병변에서 염증반응의 정도를 판정하는데 도움이 된다. 그렇지만 객담 결핵균의 음전으로 정의되는 '활동성'과 1:1로 일치하지는 않았다.

• Tuberculosis and Respiratory Diseases
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• 제67권4호
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• pp.331-337
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• 2009

Background: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). Methods: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. Results: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. Conclusion: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.

• Journal of Oral Medicine and Pain
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• 제1권1호
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• pp.8-13
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• 1973

The authors had studied the oral environmental changes by salivary salivary pH, amount, periodontal Index in patient with active pulmonary tuberculosis patients. Among the subjects, The experimental group was consisted of 100 patients (50 males and 50 females) of 20-29 years and 100 persons of control group (50 males and 50 females) of 20-29 years. The measurement of salivary amount was performed with wide mouthed plastic (2 Inches) bottle for avoidance of Ionization of SiO2 by using of glass bottle and salivary pH was checked by pH meter 27 radiometer Copenhagen. The results are as follows : 1. The slivary pH does not appear to be characteristic of tuberculous paticents. 2. The obtained salivary amount indicated no significant to the tuberculous patients as compared to the obtained supposedely wealthg individuals. 3. The Russel Index wasfound higher and there had found more periodontal involvement(3 times than normal) in the experimental group.

• Journal of Chest Surgery
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• 제25권7호
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• pp.711-715
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• 1992

Massive hemoptysis is defined as pulmonary hemorrhage of more than 600ml to 800ml within 24hours. Among the many causes, the most common include pulmonary tuberculosis, abscess, bronchiectasis, cystic fibrosis bronchial carcinoma. Most acute episodes of hemoptysis last less than 24 hours and gradually subside. However, when the hem-optysis is massive, it carries a mortality rate of 50% to 100%. It is generally agreed that surgery is the treatment of choice for patients with massive hemoptysis. We had the one case of 39 year-old male with recurrent massive hemoptysis. In the past history, he had pulmonary tuberculosis 20 years ago but no chest trauma, Previous chest CT showed well defined cavitary lesion with calcification on RUL Under the bronchoscope finding, we indentified active bleeding from right upper lobe bronchus without end-obronchial lesion. Therefore, emergency thoracotomy was done with impression of hem-optysis due to pulmonary tuberculosis. But operative findings were as follows ; the 4th fractured rib was impacted into the lung parenchyme with severe adhesion and middle lobe was not inflated. So, Upper and middle lobectomy were performed. He was diagnosed finally by operative and pathological findings as massive hemoptysis due to impaction of fractured rib into the lung parenchyme and discharged without complication.