Medical History Of Tuberculosis Research Articles

Rare primary pulmonary mucosa-associated lymphoid tissue lymphoma misdiagnosed with tuberculosis: A case report.

Primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) is a rare subtype of non-Hodgkin lymphoma with a relatively low incidence rate clinically. Atypical clinical symptoms and nonspecific chest computed tomography features of the disease make it difficult to determine and treatment is delayed. We discuss the diagnosis and treatment of a patient with primary pulmonary MALToma to raise clinicians' awareness of this condition. A 66-year-old male patient with a medical history of tuberculosis has been experiencing progressive exacerbation of respiratory symptoms and nonresponsive treatment without an unclear diagnosis for 5 years. He was transferred to our hospital because a nonspecific soft tissue mass in the right upper lobe of the lung was found on his chest computed tomography. Laboratory results with serum immunofixation electrophoresis showed polyclonal immunoglobulin (Ig) G, IgM, IgA, and λ-light chain on admission. Pathological examination and immunohistochemical staining of lung biopsy revealed a definitive diagnosis of pulmonary MALToma with stage IV. The patient received immunotherapy with anti-CD20 monoclonal antibody (rituximab), and showed significant clinical improvement at the 6-month follow-up. Diagnosis of primary pulmonary MALToma mainly relies on histopathological examination, and comprehensive laboratory examinations are also necessary. Clinicians should combine laboratory tests (such as immunofixation electrophoresis in our case) to assist in medical diagnosis in cases of atypical clinical manifestations and imaging characteristics. Immunotherapy appears to be the main treatment protocol for advanced patients.

Tuberculosis Infection Under Anti-TNF Alpha Treatment.

Anti-tumor necrosis factor-α (TNF-α) is a life-changing treatment leading to quality-of-life improvement. Nonetheless, this treatment is associated with a high risk of infection, especially tuberculosis. Our study aimed to determine the frequency of active tuberculosis in our patients with chronic rheumatic disease and treated with TNF-α. We conducted a retrospective study including patients with Rheumatoid Arthritis and Spondylarthritis diagnosed according to ACR/EULAR 2009 criteria and ASAS 2010, respectively, and treated with biological agents for at least 6 months. We collected data regarding tuberculosis screening and the occurrence of active tuberculosis during follow-up. 82 patients were included (37 men and 45 women). The mean age was 42 ± 3.4 years. At inclusion, no patient had a medical history of tuberculosis. The diagnosis of latent tuberculosis infection was established in 17 patients (20.7%). Prophylactic treatment was prescribed in all these cases for three months. Two cases (2.4%) of active tuberculosis occurred under biologic (infliximab). It was two severe forms of tuberculosis. The first case had miliary tuberculosis associated with hepatic and peritoneal involvement. The second one had pleural tuberculosis. These two patients received anti-tuberculosis therapy, and the biological treatment was interrupted. Given the high disease activity, the anti-TNF-α was restarted after 3 and 4 months. There was no recurrence of tuberculosis after 7 years of follow-up. The use of TNF-α blockers is associated with a risk of disseminated forms of tuberculosis. Tuberculosis screening, which is recommended before the biological onset, is also necessary under this treatment. Restarting the anti-TNF-α after appropriate treatment of tuberculosis seemed to be safe.

Factors influencing transmission of tuberculosis in Ngeu Nata culture among Ngada community in Kupang, East Nusa Tenggara, Indonesia: Cross sectional study.

BackgroundEating “sirih/Betel” (Ngeu Nata) as a culture in Ngada society can become one of the primary source of Tuberculosis (TB) transmission due to share leaves and betel liquid reservoirs together with other people. If one of the people who share leaves is a TB patient, it can transmit TB to other person. The purpose of this study was to identify the factors that influence TB transmission in Ngeu Nata culture using the health belief model approach.Design and MethodsThis study used cross-sectional, involving 110 respondents, selected by consecutive sampling. The respondents were Bajawa ethnicity, age 36-67, at least consume Betel one a day together with other person in Ngada district, East Nusa Tenggara.ResultsThe results showed that most respondents had high transmission behavior in betel eating culture (51.8%). Factors related to TB transmission behavior: medical history of TB (p=0.028), knowledge about TB (p=0.038), the perceived of severity of TB (p=0.037); the perceived of benefits (p=0.039) and the perceived of barrier (p=0.038). The dominant factor was knowledge, (OR 2,365 (95% CI) 1,015-5,510).ConclusionsImplication: nurses should include aspect of Ngeu Nata cultural in designing TB education for Bajawa ethnicity in order to prevent TB transmission in Ngada district, East Nusa Tenggara.

Tuberculosis — The Singapore Experience, 1867–2018: Disease, Society and the State by Kah Seng Loh and Li Yang Hsu

Reviewed by: Tuberculosis — The Singapore Experience, 1867–2018: Disease, Society and the State by Kah Seng Loh and Li Yang Hsu Por Heong Hong Tuberculosis — The Singapore Experience, 1867–2018: Disease, Society and the State, by Kah Seng Loh and Li Yang Hsu, New York, Routledge, 2020, 169 pp. ISBN 9780367354534 Diseases rarely become a subject of historical studies in the region. This book is no doubt an important contribution, not only to the general historical studies of Singapore and Malaya, but also to the historical studies of diseases in the region. More importantly, unlike past historical studies of diseases, which were largely dominated by physicians, this book on tuberculosis in Singapore is co-written by a social historian, Loh Kah Seng, and an infectious disease physician, Hsu Li Yang. As the title of the book suggests, it is not a medical history of tuberculosis. On the contrary, it is a social and political history of the disease, which places the activities and views of various historical actors, including physicians, politicians, activists of NGOs, patients, Asians and Europeans, elites and working class, under the analytical gaze of the two authors. In short, this is a history of disease that goes ‘beyond hospitals and doctors’ (p. 155). Drawing predominantly from colonial documents, and a small number of oral histories and personal memories, the book is divided into nine chapters including the introduction and conclusion. The narratives of the book flow chronologically to chart the social construction of tuberculosis from colonial to post-colonial era. Covering a period of over one and a half centuries, Singapore’s history of tuberculosis is periodised into different themes, reflected in the title of each chapter. On the outset, the authors conceptualize tuberculosis as ‘a social and intellectual construct and a political battlefield’ (p. 2). They contextualize the disease by situating it against the background of several social forces and trends, such as colonialism, migration, and transnational flow of ideas of sanitation and evolutionary theories during colonial era, the drive of decolonization during post-war years, and the desire of nation building after independence. Urban housing, conceived a cause as well as a solution to the spread of tuberculosis, is an issue of concern that cuts across all three eras. The dynamics between the metropole and the colony, between elites of different ideologies in the colonial administration, and between people at the giving and the receiving ends of social engineering, jointly shaped the evolution and the treatment of the disease. Starting from the nineteenth century Singapore, tuberculosis was closely linked to pauperism and the development of pauper hospitals, which the colonial elites had little interest in. Not until twentieth century did the disease gain more colonial administrator’s attention, a timing when the medical and social meanings of the same disease had already been transformed, from a ‘glamorous hereditary affliction of beautiful and creative elites” to a ‘vile, contagious, and stigmatizing disease of the poor and the filthy’, in the West (Snowden 2019, 292). Hence, the [End Page 231] romantic metaphor of the ‘consumptive look’ of tuberculosis sufferers as a mark of social standing and power of creativity, a social construct prevailing in the mid nineteenth century West during the pre-contagionism era, never took hold of the colony. Like its counterpart in the twentieth century West, tuberculosis in Singapore was associated not only with poverty, but also with immigrants. Similarly in both the West as well as in Singapore, the spread of tuberculosis coincided with the large influx of immigrants and rapid urbanization. While poor Irish and Italian immigrants were over represented among TB victims in New York, poor Chinese immigrants in overcrowded urban housing were the most afflicted ethnic group in Singapore. What was the colonial policy then? The Sanitary Condition of Singapore (1907), a report written by WJR Simpson, a physician who inspected Singapore’s shophouses in 1906, was a paradigm shift that shaped not only colonial policy on tuberculosis, but also that on urban housing. The report eventually became a template for today’s state built public housing in Singapore. Simpson’s suggestion was in line with comparable practices in the metropole, which viewed environmental deterioration and congested dwellings in urban space...

Oleothorax: Review of Literature; Report of a Case Study and a Potential Treatment for Multi-Resistant Tuberculosis (MRTB)

An 83 year-old-female died of dementia with history of no previous disease. On dissection, paraffin was found in the right pleural cavity, indicated that the person received therapy for cavitary tuberculosis in the 1940s or1950s but no gross evidence of pulmonary or pleural tubercular disease was identified in the patient. Literature review on oleothorax indicated several reported complications of oleothorax. This case notes the lack of any apparent complications caused by oleothorax. In this paper, we present a case and outlines the importance of oleothorax in the medical history of tuberculosis, and as a potential treatment for multi-resistant tuberculosis (MRTB).

Peculiarities of multidrug-resistant tuberculosis on the background of idiopathic pulmonary fibrosis (a clinical case report)

Objective – familiarization of practitioners with the peculiarities of pulmonary multi-drug resistant tuberculosis (MDRT) in a patient with idiopathic pulmonary fibrosis (IPF) resulted from a long exposure to environmental factors at the workplace.Materials and methods. The article deals with a clinical case of own observation of pulmonary MDRT development in a patient with IPF. The patient was hospitalized in the Pulmonary Tuberculosis Department No 3 (Department of Resistant Tuberculosis) of the Clinical Site of Phthisiology and Pulmonology Department of Zaporizhizhia State Medical Univercity in the CI “Zaporizhzhia Regional Tuberculosis Clinical Dispensary”.The results of our own observations. Patient: male, 41 years, no medical history of tuberculosis. His work was associated with a harmful environmental factor within 7 years: dust in the workplace (refueling and repair of powder-type fire extinguishers). After 3 weeks of inpatient treatment, the patient died. The presented clinical case demonstrates the complexity of a life-time IPF diagnosis, which progression provoked the development of an equally serious disease, such as multi-resistant disseminated pulmonary tuberculosis and the prescription of antimycobacterial therapy. The cause of death was a progressive pulmonary fibrosis, and as a result, a progressively worsening pulmonary heart disease.Conclusions. Practitioners should be especially vigilant and attentive while dealing with a patient having a history of harmful environmental factors exposure that may cause IPF development. It must be borne in mind that IPF may be asymptomatic for a long time resulting in increased risk for developing tuberculosis. This case confirms the literature data that the development of pulmonary MDRT in patients with untreated IPF leads to a rapid fatal outcome in the vast majority of cases (in this case it was 3 weeks).

Recurrence of allergic bronchopulmonary aspergillosis after adjunctive surgery for aspergilloma: a case report with long-term follow-up

BackgroundCoexistence of aspergilloma and allergic bronchopulmonary aspergillosis (ABPA) has rarely been reported. Although the treatment for ABPA includes administration of corticosteroids and antifungal agents, little is known about the treatment for coexisting aspergilloma and ABPA. Furthermore, the impact of surgical resection for aspergilloma on ABPA is not fully understood. Here, we present an interesting case of recurrent ABPA with long-term follow-up after surgical resection of aspergilloma.Case presentationA 53-year-old man with a medical history of tuberculosis was referred to our hospital with cough and dyspnea. Imaging revealed multiple cavitary lesions in the right upper lobe of the lung, with a fungus ball and mucoid impaction. The eosinophil count, total serum immunoglobulin E (IgE), and Aspergillus-specific IgE levels were elevated. Specimens collected on bronchoscopy revealed fungal filaments compatible with Aspergillus species. Based on these findings, a diagnosis of ABPA with concomitant aspergilloma was made. Although treatment with corticosteroids and antifungal agents was administered, the patient’s respiratory symptoms persisted. Therefore, he underwent lobectomy of the right upper lobe, which resulted in a stable condition without the need for medication. Twenty-three months after discontinuation of medical treatment, his respiratory symptoms gradually worsened with a recurrence of elevated eosinophil count and total serum IgE. Imaging revealed recurrent bronchiectasis and cavities with mucoid impaction in the right lower lobe, suggesting relapse of aspergilloma and ABPA. Corticosteroids and antifungal agents were re-administered; aspergilloma improved slightly over a 5-year period, and ABPA remained well controlled with low-dose prednisolone (5 mg/day).ConclusionsWe describe the long-term follow-up outcomes of a patient with concomitant ABPA and aspergilloma, who underwent surgical resection for aspergilloma. Physicians should carefully monitor patients with coexisting ABPA and aspergilloma, as the condition may relapse after remission, even despite surgical resection for aspergilloma. Additionally, surgical resection for aspergilloma could result in resolution of ABPA.

Utilization of Chinese medicine for respiratory discomforts by patients with a medical history of tuberculosis in Taiwan

BackgroundTuberculosis (TB) is one of the world’s major communicable infectious diseases, and it still imposes a great health burden in developing countries. The development of drug-resistant TB during the treatment increases the treatment complexity, and the long-term pulmonary complications after completing treatment raise the epidemic health burden. This study intended to investigate the utilization of Chinese medicine (CM) for respiratory symptoms by patients with a medical history of TB in Taiwan.MethodsWe analyzed a cohort of one million individuals who were randomly selected from the National Health Insurance Research Database in Taiwan. The inclusion criteria of patients (n = 7905) with history of TB (ICD-9-CM codes 010–018 and A02) were: (1) TB diagnosed between January 1, 1997 and December 31, 2010 (2) 18 years old or over (3) Clinical records for at least 2 months with complete demographic information (4) Record of treatment with first-line TB medication prescriptions. CM users for conditions other than respiratory discomforts (n = 3980) were excluded. Finally, a total of 3925 TB patients were categorized as: CM users for respiratory discomforts (n = 2051) and non-CM users (n = 1874).ResultsAmong the 3925 subjects, 2051 (52.25%) were CM users, and 1874 (44.753%) were non-CM users. Female patients and those who were younger (18–39 y/o) and who lived in urbanized areas relatively tended to be CM users (p < .0001). Most of the CM users (1944, 94.78%) received Chinese medicines. The most commonly prescribed herbal formulas and single herbs were Xiao-Qing-Long-Tang and Radix Platycodonis (Jie-Geng), respectively. The core pattern of Chinese medicines for TB patients consisted of Ma-Xing-Gan-Shi-Tang, Bulbus Fritillariae Thunbergii (Bei-Mu), Radix Platycodonis (Jie-Geng) and Semen Armeniacae (Xing-Ren).ConclusionsThe use of CM is popular among patients with a medical history of TB complicated with long-term respiratory discomforts in Taiwan. Further pharmacological investigations and clinical trials are required.

Risk of Sarcopenia and Osteoporosis in Male Tuberculosis Survivors: Korea National Health and Nutrition Examination Survey

Short-term prospective studies have suggested that pulmonary tuberculosis (TB) preludes permanent loss of lean tissue and fat mass even when TB treatment is effective. The aim of this study was to estimate the risk of sarcopenia and osteoporosis among Korean male TB survivors. Data of the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008–2011) were analyzed, including 3,228 males aged 50 years or older who underwent chest X-ray (CXR) and dual-energy x-ray absorptiometry (DEXA). TB survivors having both medical history and TB scars on CXR had increased risk of sarcopenia (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.79–6.68) and osteoporosis (OR 1.75, 95% CI 1.04–2.95) after adjusting for age, height, smoking, alcohol, physical activity, serum 25-hydroxyvitamin D, parathyroid hormone level, education, and fat mass index. Having TB scars on CXR without medical history of TB was an independent risk factor of sarcopenia (OR 2.05, 95% CI 1.05–4.00), but not a risk factor of osteoporosis. Sarcopenia and low bone mineral density are prevalent in pulmonary TB survivors with TB scars on CXR. Medical history of TB with TB scars on CXR is an independent risk factor for sarcopenia and osteoporosis.

Pulmonary Tuberculosis Incidence and Risk Factors in Rural Areas of China: A Cohort Study

The incidence of tuberculosis (TB) and its risk factors in China remains unclear. This study examined TB incidence and relative risk factors in rural areas of China. Participants (n = 177,529) were recruited in Xiangtan County (in the central area of China) and in Danyang County (in the eastern area of China) in 2009 and a followed-up study was conducted for one year. The incidence density of pulmonary TB and smear-positive TB were 91.6 (95% CI: 78.7, 106.0) per 100,000 person-year and 36.7 (95% CI: 33.1, 52.4) per 100,000 person-year respectively in Xiangtan, and 47.3 (95% CI: 38.2, 57.5) per 100,000 person-year and 22.7 (95% CI: 16.5, 30.8) per 100,000 person-year in Danyang. The medical history of TB was associated with TB, with the relative risk (RR) of 7.00 (95% CI: 2.76, 17.18) in Xiangtan and that of 31.08 (95% CI: 13.22, 73.10) in Danyang. The association between TB and per capita living space over median was found in Xiangtan, with the RR of 1.86 (95% CI: 1.15, 3.01). No association was found between TB and the insurance status, the contact history with TB, the history of diabetes, smoking, or per capita annual income. The host genetic susceptibility, and social factors such as education and income could be considered in future studies.

Evaluation of Mycobacterium kansasii isolates from a clinical laboratory in a city hospital

Fifteen isolates of Mycobacterium kansasii in Showa University Fujigaoka Hospital between 1982 and 1995 were investigated. Comparing by gender, 13 were isolated from male patients and only two were isolated from female patients. The average of cases was 48 years old and 14 out of 15 cases (93%) were isolated from respiratory tract specimens. The rate of the smear- and culture-positives was 64%, which was significantly higher than that (26%) of M. avium complex (p < 0.01 by chi 2 test). All 4 isolates were susceptible to rifampicin (10 micrograms/ml) by drug susceptibility testing using Ogawa egg medium, and only 1 was resistant to ethambutol (2.5 micrograms/ml). Seven out of 10 patients whose medical record was available were diagnosed as pulmonary infection with M. kansasii. Two out of 4 patients with primary infection type had underlying diseases such as diabetes mellitus and leukemia, while the remaining two patients did not have any underlying disease. Two out of 3 patients with secondary infection type had a medical history of tuberculosis and the remaining 1 patient had infected pulmonary cyst. Such as Pseudomonas aeruginosa, Enterobacter aerogenes and Flavobacterium spp., and Branhamella catarrhalis, associated with M. kansasii, bacteria more than 10(7) cfu/ml were isolated from the sputa of 3 patients with leukemia, infected pulmonary cyst and post-tuberculosis, respectively. M. kansasii, Stenotrophomonas maltophilia (10(7) cfu/ml) and Candida albicans were detected from the sputum of 1 patient with nephrosis, for which steroid (predonin) and antibiotics (piperacillin and latamoxef) were administrated, however, this patient was not diagnosed as a case of M. kansasii infection. These findings suggest the fact that M. kansasii inhabits among compromised hosts of a city hospital.

Clinical Characteristics of Genitourinary Tuberculosis during a Recent 10-Year Period in One Center

PurposeThis study was conducted to analyze the clinical characteristics and treatments of patients with genitourinary tuberculosis (GUTB) over the past 10 years.Materials and MethodsThe study population comprised 101 patients who were diagnosed with GUTB and hospitalized from January 2000 to December 2009. Acid-fast bacilli (AFB) smear, urine tuberculosis culture, urine tuberculosis polymerase chain reaction (PCR), intravenous urography, cystoscopy, and histopathologic findings were used for patient selection. Yearly proportion, gender, patient distribution according to age, history of tuberculosis, and presence of other organ tuberculosis were analyzed.ResultsThe patients hospitalized with GUTB counted for 0.9% of all patients admitted to the department of urology. The sex ratio was 1:1.53 (male:female), and the patients' mean age was 45.57±12.55 years (range, 19-81 years). Among the patients, there was one immunocompromised patient. A total of 22 patients (21.8%) had a medical history of tuberculosis, mostly pulmonary tuberculosis (90.9%). The sensitivity of AFB stain, tuberculosis culture, and PCR was 41.6%, 55.4%, 33.7%, respectively. A total of 54 patients required additional surgical treatment: 30 cases of nephrectomy, 8 cases of epididymectomy, 8 cases of ureteral stent, 5 cases of nephrostomy, 1 case of ureterectomy, 1 case of augmentation cystoplasty, and 1 case of transurethral resection of prostate.ConclusionsThe frequency of GUTB tended to decrease progressively. However, GUTB is still a threat to public health. There was no previous history of tuberculosis in two-thirds of the cases of GUTB and more than half of them required further surgical treatment.

Tuberculosis in a patient on temozolomide: a case report

Temozolomide (TMZ) is a cytotoxic agent of the imidazotetrazine class, chemically related to dacarbazine. Its use poses higher risks of lymphopenia and opportunistic infections. Prophylaxis for Pneumocystis jiroveci must be considered up to 12 months after treatment discontinuation. The due literature (MEDLINE) makes no mention of a possible connection between the use of TMZ and tuberculosis (TB). A female patient, aged 59, featuring glioblastoma multiforme and having undergone solely a brain biopsy, was submitted to TMZ along with radiotherapy. After the first TMZ maintenance cycle, the referred patient was admitted displaying a background of a 40-day afternoon fever and productive coughing. She was thus submitted to a bronchoscopy and LBA, which resulted BAAR 1+/4+. TMZ was then suspended, and rifampicin, isoniazid, and pyrazinamide introduced. Considerations on prophylaxis with isoniazide in cancer patients are long-lived and scarce. Some subgroups are likely to benefit from the prophylactic administration of isoniazide during TMZ treatment, such as those patients under high doses of corticoids, patients with past medical history of TB, the malnourished, patients from endemic regions, and patients with highly reactive tuberculinic tests. That, nevertheless, must not restrict the administration of TMZ, but, rather, stand for a warning about its possible toxicity, and thus mitigate complications.

Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America

The aim of the present study was to evaluate the association between history of tuberculosis and airflow obstruction. A population-based, multicentre study was carried out and included 5,571 subjects aged > or =40 yrs living in one of five Latin American metropolitan areas: Sao Paulo (Brazil); Montevideo (Uruguay); Mexico City (Mexico); Santiago (Chile); and Caracas (Venezuela). Subjects performed pre- and post-bronchodilator spirometry and were asked whether they had ever been diagnosed with tuberculosis by a physician. The overall prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity post-bronchodilator <0.7) was 30.7% among those with a history of tuberculosis, compared with 13.9% among those without a history. Males with a medical history of tuberculosis were 4.1 times more likely to present airflow obstruction than those without such a diagnosis. This remained unchanged after adjustment for confounding by age, sex, schooling, ethnicity, smoking, exposure to dust and smoke, respiratory morbidity in childhood and current morbidity. Among females, the unadjusted and adjusted odds ratios were 2.3 and 1.7, respectively. In conclusion, history of tuberculosis is associated with airflow obstruction in Latin American middle-aged and older adults.

Sozialgeschichte der Tuberkulose: Vom Kaiserreich bis zum Ende des Zweiten Weltkriegs unter besonderer Berücksichtigung Württembergs (review)

While the medical history of tuberculosis is of great fascination, going from antiquity through Robert Koch's discovery of the tubercle bacillus and Selman Abraham Waksman's discovery of streptomycin (the first effective drug against tuberculosis), the social history likewise offers many aspects worthy of study and interpretation. Sylvelyn Hähner-Rombach has compiled a wealth of data and offers a careful analysis of TB's impact on society. She has done so in the context of her doctoral dissertation, using as her primary source archival material for the southern German state or province of Württemberg, limiting the time span to roughly between 1890 and the end of World War II (1945).

Clinical Features of Simple Bronchial Anthracofibrosis which is not Associated with Tuberculosis

Background : Bronchial anthracofibrosis (BAF) is a dark black or brown pigmentation of multiple large bronchi associated with a fibrotic stenosis or obliteration that is incidentally found during a diagnostic bronchoscopy some reporters have suggested endobronchial tuberculosis or tuberculous lymphadenitis as a possible cause of BAF. However, some BAF patients do not have any medical history of tuberculosis. The aim of this study was to elucidate the clinical features of simple BAF patients, which were not associated with tuberculosis. Methods : We reviewed the patients' charts retrospectiely and interviewed all BAF patients who were followed up for 1 year or more. Among the 114 BAF patients, 43 patents (38 %) had no associated tuberculosis, cancer and pneumoconiosis. The clinical characteristics, radiological findings and associated pulmonary diseases of these patients were evaluated. Results : Most patients were non-smokers, old aged, housewifes who resided in a farming village. The common respiratory symptoms were dyspnea, cough and hemoptysis. The predominant X-ray findings were a multiple bronchial wall thickening(89%), bronchial narrowing or atelectasis (76%) and a mediastinal lymph node enlargement with/without calcification (78%). Pulmonary function test usually showed mild obstructive ventilatory abnormalities but no patient showed a restrictive ventilatory pattern and the patients were frequently affected with chronic bronchitis(51%), post-obstructive pneumonia(40%) and chronic asthma(4%). Conclusion : Because BAF is frequently associated with chronic bronchitis and obstructive pneumonia as well as tuberculosis, a careful clinical evaluation and accurate differential diagnosis is more essential than empirical anti-tuberculous medication.

An outbreak of pulmonary tuberculosis in the dormitory of construction labors suspected to have been due to exogenous reinfection

We report an outbreak of pulmonary tuberculosis (TB) in a dormitory of construction labors, and this outbreak is suspected to have been caused by exogenous reinfection, based on the restriction fragment length polymorphism (RFLP) analysis and other findings. After a patient entered our hospital with active TB, 12 new other patients were discovered by contacts examination. These patients lived together in the same dormitory. They were all male and single, and were aged from 43 to 63 years old. Except one patient (No. 3) previously treated for TB for three months about 2 years ago and was suspected to be the index case of this outbreak, 12 other patients did not have a medical history of TB. The bacilli cultured from 11 patients (No. 1-11) were tested by RFLP analysis, three patterns were identified, and the fingerprints from 9 patients (No. 1-9) were identical, and the patterns of incomplete resistance of some antituberculous drugs were quite similar between No. 1-9 and No. 12 and between No. 10 and No. 13, respectively. The locations of the main lesions of TB on chest X-ray pictures were the apico-posterior segments of bilateral upper lobes. No signs suspected to indicate primary tuberculosis were detected. Considering the rate of tuberculous infection in Japan among the middle age and above as well as the identical RFLP results, most of patients in this outbreak except the index case No. 3 were suspected to have TB due to the exogenous reinfection.