[Epidemiological study on factors affecting the hospitalization period of patients with active tuberculosis].

OBJECTIVE: We compared the time needed for sputum negative conversion of tubercle bacilli among patients with active tuberculosis to clarify factors affecting the hospitalization period. SUBJECTS AND METHODS: We retrospectively reviewed 1260 patients definitely diagnosed as active tuberculosis between Jan. 1996 and Dec. 2003. Smears were examined by fluorescent staining procedure, and cultures were tested by egg-based Ogawa and Kudo-PD solid media. Sputum smears and cultures were examined at least once a month. All patients received standard chemotherapy including isoniazid (INH), rifampicin (RFP), ethambutol hydrochloride (EB) [or streptomycin sulfate (SM)], and pyrazinamide (PZA). Time needed for sputum conversion was defined as the period from the initiation of chemotherapy to the first documented negative smear and culture. Multivariate analysis was performed to document factors that were independently associated with hospitalization period. RESULTS: Factors correlated with longer conversion time were high amount of bacilli discharge, severe radiographic findings, and drug sensitivity at the initiation of treatment. Patients with bacilli discharge Gaffky 9-10 required 3 months (median) [3.9 months (mean)], and those with culture 3+ required 2 months (median) [2.8 months (mean)] for conversion. Patients with large and widespread cavities, classified as I or II 3 according to the Classification by the Japanese Society for Tuberculosis, required conversion time of 3 months (median) [2.8 months (mean)]. Cases with initial drug resistance to any of the drugs required 2 months (median) [2.2 months (mean)] for conversion. Factors associated with prolongation of hospitalization were the amount of bacilli in sputum at the initiation of chemotherapy, past history of tuberculosis, presence of cavities and size of lesion observed on chest X-ray, drug resistance, and presence of extra-pulmonary lesions. Gender, complication with chronic renal failure, and alcoholism did not affect the hospitalization period. CONCLUSION: Patients with huge amount of bacilli discharge, extensive cavitary lesion, or initial drug resistance required more than 2 months for sputum negative conversion. In these cases, hospitalization period shorter than 2 months is inadequate, even if chemotherapy is initiated. For complete eradication of tuberculosis, we must ensure adequate chemotherapy and hospitalization period to eliminate further sources of infection. Our study shows that hospitalization period should be cautiously determined based on the disappearance of bacilli in sputum.

Eosinophilic pleurisy induced by dantrolene.

A 70-year-old male developed eosinophilic pleurisy fifteen years after dantrolene sodium had been started for his spastic paraplegia due to spinocerebellar degeneration. Drug lymphocyte stimulation test (DLST) for dantrolene was positive. After discontinuance of dantrolene, pleural effusion gradually decreased and inflammatory reaction improved. During two-year observation, we have found no relapse of pleurisy without special medication. We present this case and compare this case with other 10 reported cases.

[A case of pulmonary Mycobacterium scrofulaceum infection presented as pleurisy].

A 68-year-old man was referred to our hospital for further examination of pleurisy. Before this admissions, he was diagnosed as having tuberculous pleurisy initially and later as having pleurisy due to SLE in another hospital. He was administered anti-tuberculous medicine including INH, RFP and EB empirically, and later prednisolone and azathioprine. Despite of these medications, there was no improvement. After admission to our hospital, positive results for acid fast bacilli were obtained from both sputum and pleural fluid, and they were identified as Mycobacterium scrofulaceum. He was treated successfully with the combination of INH, RFP, EB plus SM and CAM. The expectoration of M. scrofulaceum was ceased after 4 months of treatment. The common lesion of non-tuberculous mycobacterium is found in the lung. A non-tuberculous mycobacterium infection might accompany with pleural involvement or pleurisy. Thus in case of pleural diseases, non-tuberculous mycobacterium should also be included among differential diagnosis.

[Evaluation of cardiopulmonary function in Japanese Himalayan climbers to the Himalayas underin a hypobaric hypoxic chamber].

The Tokai University and Tibet University Scientific Friendship Expedition 2001 succeeded in reaching the summit of Kula Kangri (7,538 m) in the Himalrayas without supplementary O2 in May, 2001. Before this expedition, the cardiopulmonary function of all members was evaluated using a hypobaric hypoxic chamber in which the barometric pressure was gradually lowered to a simulated altitude of 6000 m. Whenever a member's PaO2 was lower than 40 torr during the experiment, supplementary O2 was given. The results were divided into two groups, Group A and Group B, according to whether supplementary O2 was used. Group A subjects did not need O2 even at an altitude of 6,000 m, whereas Group B subjects did when they reached an altitude of 5,000 m. Seven the eight Group A members had climbed mountains over 4,000 m several times, whereas twelve out of the thirteen members of Group B had no mountaineering experience. The mean PaO2 and PaCO2 of Group A at 6000 m were 41.9 torr and 31.9 torr, respectively, while those of Group B at 5000 m were 35.8 torr and 35.9 torr. There was a significant difference in the degree of hyperventilation between Group A and Group B. No difference was observed between the two groups in systolic and diastolic arterial blood pressure, but the heart rate in Group B increased significantly under hypoxia. These results suggest that the experience of climbing mountains over 4000 m may lead to significant differences in cardiopulmonary function under hypoxia.