• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.30-37
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• 1996

Background: The extraction methods of DNA from clinical samples are the major obstacle to use the PCR(polymerase Chain Reaction) in routine labortary for early detection of M. tuberculosis. We tried to improve the extraction method of DNA from sputum for establishment of the PCR in routine labortary by reducing the possibility of cross contamination and performing it easily and safely. Methods: We used the $InstaGene^{TM}$ DNA extraction kit(BioRad Co.) using Chelex 100 ion exchange resin for preparation of DNA. We compared InstaGene method in 100 cases of sputum from proteinase K method which is known as the most commonly used method for DNA purification(Experiment 1). And we compared InstaGene method in 98 cases of sputum from Microwave method developed by a company in Korea(Experiment 2). In experiment 1,245bps of IS6110 were amplified and then 188bps were amplified by nested PCR. In experiment 2,536bps in primary PCR and 276bps in nested PCR were amplified and analysed by agarose gel electrophoresis and EtBr staining. Results: When we chose AFB smear, culture, or AFB smear and culture as a standard test, PCR had low specificity and positive predictive value in both experiments. The InstaGene method has higher value in sensitivity and negative predictive value significantly than proteinase K method. The InstaGene method and the Microwave methods were similar in sensitivity, specificity, positive predictive value and negative predictive value. Conclusion: Even though both methods had lower possibility of cross contamination, shorter time requirement, simplicity, and economic advantages than Proteinase K method, the InstaGene method was a little simpler than the Microwave method. Therefore, in terms of usefulness in clinical application, the Instagene method seems to be the most useful method in DNA extraction for detection of M. tuberculosis using PCR. The reliability of this method will be clarified by further studies with enough clinical samples.

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.671-682
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• 1996

Background : Endobronchial tuberculosis is definded as tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence. Endobronchial tuberculosis has clinical significance due to its sequela of cicatrical stenosis which causes atelectasis, dyspnea and secondary pneumonia and may mimic bronchial asthma and pulmanary malignancy. Method : The authors carried out, retrospectively, a clinical study on 201 patients confirmed with endobronchial tuberculosis who visited the Department of Pulmonary Medicine at Hangyang University Hospital from January 1990 10 April 1996. The following results were obtained. Results: 1) Total 201 parients(l9.5%) were confirmed as endobronchial tuberculosis among 1031 patients who had been undergone flexible bronchofiberscopic examination. The number of male patients were 55 and that of female patients were 146. and the male to female ratio was 1 : 2.7. 2) The age distribution were as follows: there were 61(30.3%) cases in the third decade, 40 cases(19.9%) in the fourth decade, 27 cases(13.4%) in the sixth decade, 21 cases(10.4%) in the fifth decade, 19 cases(9.5%) in the age group between 15 and 19 years, 19 cases(9.5%) in the seventh decade, and 14 cases(7.0%) over 70 years, in decreasing order. 3) The most common symptom, in 192 cases, was cough 74.5%, followed by sputum 55.2%, dyspnea 28.6%, chest discomfort 19.8%, fever 17.2%, hemoptysis 11.5%, in decreasing order, and localized wheezing was heard in 15.6%. 4) In chest X-ray of 189 cases, consolidation was the most frequent finding in 67.7%, followed by collapse 43.9%. cavitary lesion 11.6%, pleural effusion 7.4%, in decreasing order, and there was no abnormal findings in 3.2%. 5) In the 76 pulmanary function tests, a normal pattern was found in 44.7%, restrictive pattern in 39.5 %, obstructive pattern in 11.8%, and combined pattern in 3.9%. 6) Among total 201 patients, bronchoscopy showed caseous pseudomembrane in 70 cases(34.8%), mucosal erythema and edema in 54 cases(26.9%), hyperplastic lesion in 52 cases(25.9%), fibrous s.enosis in 22 cases(10.9%), and erosion or ulcer in 3 cases(1.5%). 7) In total 201 cases, bronchial washing AFB stain was positive in 103 cases(51.2%), bronchial washing culture for tuberculous bacilli in 55 cases(27.4%). In the 99 bronchoscopic biopsies, AFB slain positive in 36.4%. granuloma without AFB stain positive in 13.1%, chronic inflammation only in 36.4%. and non diagnostic biopsy finding in 14.1%. Conclusions : Young female patients, whose cough resistant to genenal antitussive agents, should be evaluated for endobronchial tuberculosis, even with clear chest roentgenogram and negative sputum AFB stain. Furthermore, we would like to emphasize that the bronchoscopic approach is a substantially useful means of making a differential diagnosis of atelectasis in older patients of cancer age. At this time we have to make a standard endoscopic classification of endobronchial tuberculosis, and well designed prospective studies are required to elucidate the effect of combination therapy using antituberculous chemotherapy with steroids on bronchial stenosis in patients with endobronchial tuberculosis.

• Korean Journal of Clinical Laboratory Science
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• v.47 no.2
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• pp.83-89
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• 2015

Although Mycobacterium tuberculosis complex strains remain responsible for the majority of diseases caused by mycobacterial infections worldwide, the increase in HIV (human immuno deficiency virus) infections has allowed for the emergence of other non-tuberculous mycobacteria as clinically significant pathogens. M. tuberculosis was detected by two-tube nested polymerase chain reaction (PCR) and non-tuberculous mycobacteria was detected by PCR-restriction fragment length polymorphism (RFLP) with Msp I. Result of niacin test is equal to result of two-tube nested PCR after culture for M. tuberculosis. In this study, acid fast bacilli stain (AFB. stain) >2+ case, Detection of Mycobacteria is similar to result before culture and after culture. AFB. stain <1+ case, result of mycobacteria is distinguished. Conclusionly, these results suggest that identification of mycobacteria must go side by side both culture and PCR for more fast and accuracy.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.298-302
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• 2008

We experienced a case of tuberculosis presented simultaneously with pseudoaneurysm of the aorta and ARDS. A 63-year-old man was admitted with complaints of fever and right upper quadrant abdominal pain for a week. Chest X-ray on admission showed a normal finding. Sub-diaphragmatic abscess on abdomen CT scan was suspected and serosanguinous fluid was aspirated from the abscess pocket. On day 2, he was getting more dyspneic and chest X-ray revealed extensive bilateral infiltration. Aspirated fluid revealed AFB. Later, follow-up abdomen CT scan revealed a leakage of dye from the aneurysmal sac of the descending aorta which was previously diagnosed as sub-diaphragmatic abscess. An aortic stent was placed, covering the opening into the aneurysm. The sputum also showed positive AFB. The patient was successfully weaned from the ventilator, and discharged with anti-tuberculous medication on day 42. Follow-up abdomen CT scan 6 months later showed that the aneurymal sac was completely disappeared.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.54-59
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• 2006

Background: Although there have been several studies regarding the clinical value of an automated TB-PCR study using sputum, bronchial washing, and other body fluid samples for the detection of pulmonary tuberculosis, there are only a few reports on the use of fresh tissue samples. Materials and methods: The acid-fast bacilli stain(AFB), tuberculosis culture, automated TB-PCR study, and histopathology examination were performed in 42 fresh tissue samples. Results: Among the 42 cases, 18 cases were diagnosed with tuberculosis based on the clinical findings. Sixteen of the 18 cases were TB-PCR positive and of these 16 cases, only 2 cases were positive in the AFB stain or culture study. However, all 18 cases showed the histopathology findings of chronic granulomatous inflammation that was compatible with tuberculosis. Based on the clinical findings, the sensitivity, specificity, positive predictability, and negative predictability of the automated TB-PCR study were 88.9%, 100%, 100%, and 92.3% respectively. Conclusion: An automated TB-PCR assay is an important diagnostic tool for diagnosing tuberculosis in fresh tissue samples.

• Tuberculosis and Respiratory Diseases
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• v.71 no.6
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• pp.408-416
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• 2011

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique developed to allow mediastinal staging of lung cancer and also to evaluate intrathoracic lymphadenopathy. In a tuberculosis-endemic area, tuberculosis should be considered as an etiology of mediastinal lymphadenopathy. The aim of this study was to investigate the utility of the routine culture for tuberculosis from specimens of EBUS-TBNA. Methods: We prospectively performed routine culture for tuberculosis from aspiration or core biopsy specimens got from 86 patients who had undergone EBUS-TBNA due to mediastinal lymphadenopathy between March 2010 and March 2011. Results: A total of 135 lymph node aspiration and 118 core biopsy specimens were included in this analysis. We confirmed the malignancy in 62 (72.9%), tuberculosis in 7 (8.1%), sarcoidosis in 7 (8.1%), asperogillosis in 2 (2.3%) and pneumoconiosis in 2 (2.3%) patients. One lung cancer patient had pulmonary tuberculosis coincidentally and 5 patients had unknown lymphadenopathy. The number of positive culture for Mycobacterium tuberculsosis by EBUS-TBNA is 2 (1.5%) from 135 lymph node aspiration specimens and 2 (1.7%) from 118 core biopsy specimens. Out of eight patients confirmed with tuberculosis, only one patient had positive mycobacterial culture of aspiration specimen from EBUS-TBNA without histopathologic diagnosis. Conclusion: These results propose that routine culture for tuberculosis from EBUS-TBNA may not provide additional information for the diagnosis of coincident tuberculous lymphadenitis. However, if there is any possibility of tuberculous lymphadenopathy or pulmonary tuberculosis, it should be considered to perform EBUS-TBNA in patients who have negative sputum AFB smears or no sputum production.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.397-402
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• 1996

A clinical study of 36 cases of pulmonary tuberculosis that had had a surgical resection during the period of 13 years from January 1979 to December 1992 was performed in the Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital The ratio between male and female was 3.5 1 and the age of peak incidence was in the 2nd and 3rd decades. The common prodromal symptoms were chest pain (38.9 %) and hemoptysis or blood tinged sputum (36.1 %). Preoperative diagnostic examination of sputum positivity for AFB stain despite antituberculosis chemotherapy was noticed in 22.8 oyo . Surgical indications were destroyed lobe or segment with or without cavity (58.3 oyo), mass unable to differentiate from lung cancer (16.7 %), total destroyed lung (13.9 %), bronchostenosis with atelectasis and distal bronchiectasis (11.1 %). Types of resection were pneumonectomy in 16.7%, lobec omy and segmentectomy 2.7%, lobectomy 50 %, segmentectomy 27.8%, and wedge resection 2.7%. Postoperatively, pulmonary function Improved compared to the preoperative examination, although these changes were not statistically significant. One patient died of ulcerative colitis due to drug hypersensitivity, and the postoperative complications were remnant dead space in 11.1 %, spreading of tuberculosis in 5.5%, and empyema with BPF in 5.5%.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.694-699
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• 1993

Background: After the introduction of more potent antituberculous drugs and the nation-wide tuberculosis management the prevalence rate and mortality rate of pulmonary tuberculosis has been reduced continuously. But we still experienced many patients who succumbed to this disease. So we investigated the causes of treatment failure and death of patients with pulmonary tuberculosis to delineate the problems in the management of these patients. Methods: Retrospective analysis of medical records of 55 patients who died of pulmonary tuberculosis in Kyung-Hee University Hospital during the period of Mar. 1979-Feb. 1990. Results: 1) Average duration of illness was $11.9{\pm}10.1$ years. 2) The mortality rate of in-patients with pulmonary tuberculosis was 2.09%. 3) 47.3% of patients had been treated more than twice and the sputum positive rate was 52.7%. 4) Causes of death were acute respiratory failure(56.4%), asphyxia by hemoptysis(14.6%), cor pulmonale(9.1%), tension pneumothotax(7.3%), vital organ involvement(9.1%) and coexisting diseases(3.5%). Conclusion: Many of these patients had long duration of illness, persistant sputum AFB and high incidence of acute respiratory failure as a fatal complication. It seemed that patient's neglect of their disease and inadequate treatment had caused aggravation of tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.47 no.1
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• pp.57-65
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• 1999

Backround : Pneumoconiosis is the parenchymal lung disease that results from the inhalation and deposition of dust, usually mineral dust of occupational or environmental origin. Most of the pneumoconiosis can be categorized to coal workers' pneumoconiosis (CWP) in Korea. No effective treatement is currently available, and the therapy for symptomatic CWP is limited to treatment of complication. Therefore authors analyzed and reviewed clinical features and radiological findings of 95 patients with pneumoconiosis for assessing the prognostic factors in disease progression. Method: We reviewed medical records of 95 cases with pneumoconiosis including history, chest X-ray, pulmonary function test, electrocardiography, AFB stain and culture of sputum, and routine blood examination between June 1995 and June 1997 in Seonam University Namkwang Hospital. Results: All of cases are male(mean age, 57.4 years), 91 cases out of them are miners. The mean duration of exposure to dust is 18.8 years. Major clinical symptoms are dyspnea (100%), sputum (71.6%), chest pain (55.8%), cough (23.2%), and hemoptysis (6.3%). 82 % of cases are over Morgan-Seaton Grade 2 in the degree of dyspnea. Small opacity on chest x-ray is 82.1 % and large opacity is 17.9%. Small opacity has tit type (37.2%), q/q type (25.6%) and r/r type (11.5%). B type is 42.2% in large opacity. For the pulmonary function test, restrictive type is 40.3%, mixed type 19.5% and obstructive type 8.3%. The more increasing chest Xray density, the more decreasing $FEV_1$ (p<0.01). 38% of patients show tuberculosis in chest X-ray, 15.8% positive smear of acid fast bacilli in sputum. The prevalence of pulmonary tuberculosis is high in patients with poor clinical condition. The cases with the active pulmonary tuberculosis have severe dyspnea. Expired cases show 100% and 75% of positive pulmonary tuberculosis in chest X-ray and sputum examination, respectively. 75% of expired cases show the chronic cor pulmonale, who died of acute respiratory failure. Conclusion: These findings indicate that tuberculoois infection has a decisive influence on the progress and prognoois of pneumoconioois.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1154-1166
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• 1998

Background : In the management of patients whose primary chemotherapy has failed, careful assessment is essential. It is important to find out as accurate a chemotherapy history as possible. Preferably it should contain the drugs which has never used before. The purpose of present study is establishment of retreatment regimen for pulmonary tuberculosis. The present report concerns the results of retreatment of pulmonary tuberculosis patients treated at National Masan Tuberculosis Hospital. Methods : Retrospective cohort study was made of 104 drug-resistant pulmonary tuberculosis patients who were treated by five regimens between Jan. 1994 and Nov. 1996. All the patients taken medicine for second anti-tuberculosis regimens for the first time. We separated the patients by three groups(Group I ; OFX+PTA+CS+PAS+Aminoglycoside, Group II : PZA+PTA+CS+PAS+Aminoglycoside, Group III : PZA+OFX+PTA+PAS+Aminoglycoside). Results : The age distribution was most frequent in fourth decade(36patients, 34.6%) and the mean age was 42.6 year. The sex distribution was more frequent in the males(81 patients, 85.7%). There was 31 patients(29.8%) with combined diseaes, 18 patients with complication and 24 patients(27.9%) with family history. Primary chemotherapy regimens were HERZ(S or K) in 48 patients (46.2%), HER(S or K) in 41 patients(39.4%) and others in 15 patients(14.4%). Result of drug sensitivity test showed that the resistance to INH and RFP is in 68 patients(65.4%), RFP is 12 patients(11.5%), INH is in 3 patients(2.9%) and all sensitive to INH and RFP is 3 patients(2.9%). The clinical symptoms on admission were coughing(89.4%), sputum(69.2%), dyspnea on exertion(37.5%), weight loss(33.7%) blood tinged sputum(15.4%) and others. The extent of disease on the radiograph was far-advanced in 73 patients(70.2%), moderate in 28 patients(26.9%) and minimal in 3 patients(2.9%). The side effects for drugs were gastrointestinal troubles in 31 patients(29.8%), arthralgia in 22 patients(21.2%), skin rash in 12 patients(11.5%) and others. The negative conversion rate on sputum AFB smear was 85.6%(87.5% in Group I, 80.0% in Group II and 90.5% in Group III). The average negative conversion time on sputum was 4 month(4.0 month in Group I, 4.6 month in Group II and 3.0 month in Group III). Conclusion : In the retreatment of pulmonary tuberculosis, ofloxacin is useful drug for the patients who are not available to use PZA and combination of PZA and OFX can be use effectively substituting for CS.