Kekkaku : [Tuberculosis]
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The treatment of latent tuberculosis infection (LTBI) has been established as valid for patients at high risk for developing active tuberculosis. Treatment of LTBI is also considered an important strategy for eliminating tuberculosis (TB) in Japan. In recent years, interferon-gamma release assays have come into widespread use; isoniazid (INH) preventive therapy for HIV patients has come to be recommended worldwide; and there have been increases in both types of biologics used in the treatment of immune diseases as well as the diseases susceptible to treatment. ⋯ Based on this notification, the health center registers the patient, sends a public health nurse to visit the patient and give instructions, and provides medication adherence support. The patient applies at a health center for public expenses for medical care at a designated TB care facility. Pending approval in a review by an infectious disease examination council, the patient's copayment is reduced.
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The progress of genomic analysis in mycobacterium including M. tuberculosis (Mtb) allowed us to find Mtb-specific antigens, ESAT-6 and CFP-10, which induce strong interferon-gamma (IFN-gamma) from sensitized T cells. Shortly after discovery of these antigens, diagnostic tests for tuberculosis (TB) infection were developed using these antigens. Since ESAT-6 and CFP-10 are absent from all BCG substrains and most of non-tuberculous mycobacterium, these diagnostic tests are not confounded with BCG vaccination and infection of most of non-tuberculosis mycobacterium. ⋯ In this mini-symposium, data on several questions in the QFT-2G test were presented. These included the application of QFT-2G to vulnerable individuals in immune system such as infants and HIV-positives, the effects of chemotheraphy on the QFT-2G test, the prognosis of development of active TB by QFT-2G, the next generation of QFT-2G, quality assurance of the QFT-2G test, and some problems of the current QFT-2G test. It should be important to research these questions and improve IGRAs based on the basic immunology.
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Kekkaku : [Tuberculosis] · Nov 2007
Review[Diagnosis and treatment of tuberculosis or Mycobacterium avium-intracellulare complex infection in HIV-infected patients].
The clinical features of tuberculosis vary according to its CD4 count. With CD4 count >350/microL pulmonary lesions are "typical" (upper lobe infiltrates +/- cavitation). With CD4 count< 50/microL extrapulmonary TB is more common, and chest X-rays show lower and middle lobe and miliary infiltrates, usually without cavitation. ⋯ Start antiretroviral therapy simultaneously or within 1-2 weeks. In Japan, an increasing number of HIV infections are reported year after year. So HIV infection should be included in possible diagnosis for atypical Tbc or disseminated MAC infection.
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Kekkaku : [Tuberculosis] · Dec 2006
Review[Development of antituberculous drugs: current status and future prospects].
Worldwide, tuberculosis (TB) remains the most frequent and important infectious disease causing morbidity and death. One-third of the world's population is infected with Mycobacterium tuberculosis (MTB), the etiologic agent of TB. The World Health Organization estimates that about eight to ten million new TB cases occur annually worldwide and the incidence of TB is currently increasing. ⋯ The studies, however, were performed only in animal models, the further investigations and evaluations in human are required for practical use. 4. Adjunctive immunotherapy of mycobacterial infections: Toshiaki SHIMIZU, Katsumasa SATO, Haruaki TOMIOKA (Department of Microbiology and Immunology, Shimane University School of Medicine) There is an urgent need to develop new antimicrobials and protocols for the administration of drugs that are potently efficacious against intractable mycobacterial infections. Unfortunately, development of the new drugs for solving this problem is not progressing. (ABSTRACT TRUNCATED)
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CDC and ACET in U. S. A. reported that novel vaccines instead of BCG are required for the protection against infection of Mycobacterium tuberculosis worldwide. ⋯ This challenge dose normally causes death from acute respiratory infection within 4-6 months. In this particular experiment, monkeys vaccinated with HSP 65 + hIL-12/HVJ induced HSP 65-specific T-cell proliferation and improvement of chest X-P findings, resulting in an increased survival for over a year, superior to BCG group. Thus, we are taking advantage of the availability of multiple animal models (mouse, guinea pig, and monkey) to accumulate essential data of the HVJ-liposome DNA vaccine, including the vaccine efficacy and safety, for up-coming Phase I clinical trials.