[Achievement of sputum culture negative conversion by minocycline in a case with extensively drug-resistant pulmonary tuberculosis].

A 33-year male was readmitted to our hospital for the treatment of multi-drug resistant pulmonary tuberculosis in February 1993. Six years after the treatment, the left pleuropneumonectomy was done because of the enlargement of cavitary lesions with formation of fluid. Four years after the operation, M. tuberculosis from the patient was resistant to all first- and second-line anti-tuberculosis drugs. Apical lesion and cavitary lesion on the upper lung were still seen on chest X ray and sputum smear and culture were continuously positive. Minocycline and gatifloxacin were prescribed after five years of the operation. Sixteen months after changing the regimen sputum smear and culture converted negative. Chemotherapy was terminated in August 2007, two years after the negative conversion. One year after the termination of treatment no relapse occurred. We considered minocycline was effective in this case, because gatifloxacin was resistant by the drug susceptibility test and was previously used.

[Exhaled breath-generated aerosols of mycobacterium tuberculosis in patients with active pulmonary tuberculosis during normal breathing].

OBJECTIVE: It has been understood that cough-generated aerosols act as an important vector for the spread of pulmonary tuberculosis. Humans commonly exhale aerosols during the normal respiration process that contain small droplets of the airway lining fluid. We aimed to determine whether aerosols exhaled by active pulmonary tuberculosis (AP-TB) patients may contain droplets with Mycobacterium tuberculosis (M-TB) during normal breathing. METHODS: Preliminarily, the collection efficiency of M-TB that was suspended in normal saline or distilled water was examined after subjecting the suspension to centrifugation at 3,000 g for 20 minutes. Better collection efficiency was observed in case of M-TB suspended in distilled water than that suspended in normal saline after centrifugation. Therefore, we selected distilled water instead of normal saline to prepare the fluid that was bubbled with exhaled breath. AP-TB patients with smear positive pulmonary tuberculosis who were being treated with anti-TB drugs for less than 7 days or those before the initiation of therapy expired into a 50-ml tube containing 10 ml distilled water for 30 minutes. We also prepared an exhaled breath condensate by cooling exhaled air through the tubing apparatus. RESULTS: In case of 20 AP-TB patients, the distilled water bubbled with the exhaled breath were negative for M-TB on smear, culture, and PCR (polymerase chain reaction) detection methods. The exhaled breath condensates were also negative in 24 AP-TB patients. CONCLUSION: These results suggest that exhaled breath-generated aerosols from AP-TB patients during normal breathing do not act as a vector for the spread of pulmonary tuberculosis.