Multiplex PCR을 이용한 Mycobacterium bovis와 Mycobacterium tuberculosis의 동정

장영부 ( Young Boo Jang ),김재명 ( Jae Myung Kim ),최재영 ( Jae Yeong Choe ),이햇님 ( Haet Nim Lee ),정석찬 ( Suk Chan Jung ),박영길 ( Young Kil Park ),구복경 ( Bok Kyung Ku ) 한국예방수의학회(구 한국수의공중보건학회) 2011 예방수의학회지 Vol.35 No.4

Tuberculosis (TB) is a significant disease for both humans and animals worldwide. The genus Mycobacterium includes several species that cause TB disease in humans and other animals. Amongst the members of the Mycobacterium tuberculosis complex (MTC), M. tuberculosis is mainly a human pathogen, whereas M. bovis has a broad host range and is the principal agent responsible for TB in domestic and wild mammals. M. bovis also infects humans, causing zoonotic TB through ingestion, inhalation. M. bovis accounts for only a small percentage of the reported cases of TB in humans. In recent years, TB in farmed deer has become a disease as public health importance in several countries. Nowadays, there has been rapid outbreak of bovine TB in cattle and deer in Korea. Investigations are needed to elucidate the relative importance of M. bovis on TB incidence in humans, especially in Korea where bovine TB remains a problem. Also, the human sources as the cause of animal infection, M. tuberculosis from the farm workers also important for TB control of animals in Korea. Differentiation between the causative organisms may only be achieved by sophisticated laboratory methods involving bacteriological characteristics, biochemical properties, and routine resistance to pyrazinamide (PZA). M. bovis shows inherently resistant to PZA whereas M. tuberculosis is susceptible to PZA. In this study, we developed a multiplex-PCR assay based on a 12.7-kb fragment for the differential detection of M. bovis and M. tuberculosis. A total of 131 M. tuberculosis complex isolates were randomly obtained from cattle and deers that were PPD positive. they all yielded M. bovis. M. tuberculosis was not isolated from animals. and, a total of 25 M. tuberculosis complex isolates which is resistant to PZA were obtained from patient. PZA resistant MTC in humans was caused entirely by M. tuberculosis. The multiplex-PCR protocol was highly species-specific and time saving for identification of M. bovis and M. tuberculosis. This multiplex-PCR assay will be easily used as a routine monitoring tool in veterinary and medical laboratories.

Invasive Pulmonary Aspergillosis-mimicking Tuberculosis

Kim, Sung-Han,Kim, Mi Young,Hong, Sun In,Jung, Jiwon,Lee, Hyun Joo,Yun, Sung-Cheol,Lee, Sang-Oh,Choi, Sang-Ho,Kim, Yang Soo,Woo, Jun Hee Oxford University Press 2015 Clinical infectious diseases Vol.61 No.1

<P>The computed tomography (CT) findings for about one-third of the cases of pulmonary tuberculosis in transplant recipients were very close to those of invasive pulmonary aspergillosis, although certain CT findings appeared to be helpful in differentiating between them.</P><P><B><I>Background.</I></B> Pulmonary tuberculosis is occasionally confused with invasive pulmonary aspergillosis (IPA) in transplant recipients, since clinical suspicion and early diagnosis of pulmonary tuberculosis and IPA rely heavily on imaging modes such as computed tomography (CT). We therefore investigated IPA-mimicking tuberculosis in transplant recipients.</P><P><B><I>Methods.</I></B> All adult transplant recipients who developed tuberculosis or IPA at a tertiary hospital in an intermediate tuberculosis-burden country during a 6-year period were enrolled. First, we tested whether experienced radiologists could differentiate pulmonary tuberculosis from IPA. Second, we determined which radiologic findings could help us differentiate them.</P><P><B><I>Results.</I></B> During the study period, 28 transplant recipients developed pulmonary tuberculosis after transplantation, and 80 patients developed IPA after transplantation. Two experienced radiologists scored blindly 28 tuberculosis and 50 randomly selected IPA cases. The sensitivities of radiologists A and B for IPA were 78% and 68%, respectively (poor agreement, kappa value = 0.25). The sensitivities of radiologists A and B for tuberculosis were 64% and 61%, respectively (excellent agreement, kappa value = 0.77). We then compared the CT findings of the 28 patients with tuberculosis and 80 patients with IPA. Infarct-shaped consolidations and smooth bronchial wall thickening were more frequent in IPA, and mass-shaped consolidations and centrilobular nodules (<10 mm, clustered) were more frequent in tuberculosis.</P><P><B><I>Conclusions.</I></B> Certain CT findings appear to be helpful in differentiating between IPA and tuberculosis. Nevertheless, the CT findings of about one-third of pulmonary tuberculosis cases in transplant recipients are very close to those of IPA.</P>

소아청소년에서 기관지 내시경을 통해 진단된 기관지 결핵의 임상 경과

서정민,조중범,이정현,안강모 대한 소아알레르기 호흡기학회 2012 Allergy Asthma & Respiratory Disease Vol.22 No.2

Purpose : The incidence of endobronchial tuberculosis in children is unknown, due to the inconsistent implementation of bronchoscopy in pediatric patients with pulmonary tuberculosis. In this study, our aim was to determine the incidence and clinical course of endobronchial tuberculosis in children. Methods : We performed a retrospective chart review of patients less than 18 years of age,who was diagnosed with endobronchial tuberculosis via fiberoptic bronchoscopy. Results : Out of the 101 patients with pulmonary tuberculosis, 16 patients had endobronchial tuberculosis. The median age at diagnosis was 11.2 years (range, 5 months to 16.1 years). Tuberculin skin test was positive in 9 cases (56.2%), and 6 patients (37.5%) had a history of household contact with tuberculosis. Consolidation lesion was common in the simple chest radiographs of patients with endobronchial tuberculosis. According to the bronchoscopic finding,actively caseating type was most common (43.8%). Nine of the 16 patients of endobronchial tuberculosis progressed to bronchial obstruction and 4 patients underwent pneumonectomy or lobectomy. Fibrostenotic and tumorous type tend to progress to endobronchial obstruction compared with actively caseating type. Conclusion : The incidence of endobronchial tuberculosis in pediatric pulmonary tuberculosis was 15.8%. Early detection and effective treatment of endobronchial tuberculosis are important to decrease the secondary complication, such as bronchial obstruction. 목 적 : 소아청소년 폐결핵 환자에서 기관지 내시경을 일상적으로 사용하지 않지 때문에 소아청소년 폐결핵 환자에서 기관지 결핵의 발병률은 정확하게 알려져 있지 않다. 본연구에서는 기관지 내시경을 통해서 진단된 기관지 결핵 환자의 발병률과 임상 경과를 알아보고자 하였다. 방 법: 1995년 1월부터 2011년 1월까지 삼성서울병원에서 폐결핵을 진단 받은 18세 미만의 환자 중에서 기관지내시경을 통해 기관지 결핵을 진단 받은 환자를 대상으로하였다. 의무 기록을 후향적으로검토하여 성별, 나이, 결핵피부 반응, 결핵 환자와 접촉 유무, 내원 당시의 주 호소 증상, 단순 흉부 방사선 검사 소견, 객담 혹은 위 흡인액 그리고 기관지 세척액의 미생물학적 검사 결과, 진단 시의 기관지 내시경 소견 및 추적 기관지 내시경 검사 소견 그리고 치료 결과를 조사하였다. 결과:전체 101명의 폐결핵 환자 중에서 기관지내시경을 통해 16명이 기관지 결핵으로진단받았다. 이 중 여자가9명(56.2%)였으며 진단 당시의 중앙 나이는 11.2세(범위,5개월-16.1세)였다. 결핵 환자와의 접촉력이 있었던 경우가 6명(37.5%)이었고, 투베르쿨린 반응 검사에서 양성을보인 경우가 9명(56.2%)이었으며, 단순 흉부 방사선 촬영상 폐경화를 보인경우가 7명(43.8%)으로가장 많았다. 객담이나 위 흡인액으로 결핵균 검사를 시행한 12명 중에서,항산균 도말 검사에서4명(33.3%), 배양 검사와 중합 효소연쇄 반응(polymerase chain reaction, PCR)검사는 각각7명(58.3%)에서 양성 반응을 보였다. 기관지 세척액으로결핵균 검사를 시행한 16명 중에서 항산균 도말 검사에서7명(43.8%), 배양 검사는 8명(50%), 그리고 PCR 검사는13명(81.3%)에서 양성 반응을 보였다. 기관지 내시경 소견에 따른 분류 상 건락성 괴사형이 7명(43.8%)으로 가장많았다. 9명(56.3%)은 추적 관찰에서 기관지 협착을 보였으며, 4명(25%)은 폐 절제술을 받았다. 기관지 내시경 소견 상 섬유 협착형과 종양형이 건락성 괴사형에 비해서 기관지 폐쇄로 진행하는 경우가 더 많았다. 결 론 : 국내 소아청소년의 기관지 결핵 발병률은 폐결핵환자의 15.8%였다. 기관지 결핵은 기관지폐쇄의 합병증을생기게 하여 수술적 치료까지 필요한 상황으로 이어질 수있으므로, 합병증을 줄이기위한 조기진단과 적절한치료가필요할 것으로 사료된다.

혈청학적 방법을 이용한 결핵 진단 방법의 효용성

김덕겸,권성연,이석영,박계영,정경해,이춘택,유철규,김영환,한성구,심염수,Kim, Deog-Kyeom,Kwon, Sung-Youn,Lee, Suk-Young,Park, Gye-Young,Jung, Kyung-Hae,Lee, Chun-Taek,Yoo, Churl-Gyoo,Kim, Young-Whan,Han, Sung-Koo,Shim, Yong-Soo 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.5

연구배경: 객담 도말 및 배양 검사나 방사선학적 검사 등의 기존의 결핵 진단 방법은 낮은 민감도와 진단까지 소요되는 기간이 길다는 단점이 있어서 결핵의 조기 진단 및 치료에 제한점이 있었다. 최근에 혈청학적 진단 방법의 하나로 개발된 immunochromatographic assay 기구들이 소개되고, 외국에서 비교적 높은 진단율를 보여, 결핵 유병율이 높은 국내에서 그 유용성을 평가하고, 질병 양상에 따른 차이점을 조사하여, 기존의 결핵 진단 방법들의 문제점을 해결할 수 있는지 알아보고자하였다. 연구방법: 환자군을 폐결핵 환자군(36명), 폐외결핵 환자군(3명) 및 두 가지 모두 이환된 군(22명)으로 나누었으며, 대조군은 과거 결핵 병력이 있는 비활동성 결핵환자(17명), 결핵이외의 폐질환자(16명) 및 폐질환이 없는 심장 환자(14명)를 대상으로 38kDa 항체를 포함한 ICT tuberculosis 또는 BioSign$^{TM}$TB를 이용하여 혈청화적 검사를 시행하였다. 결 과: ICT tuberculosis를 사용한 경우, 환자군 56명 및 대조군 47명에 대하여 64.3%의 민감도 및 91.5%의 특이도를 나타내었으며, 폐결핵만 있는 환자군에서 76.5%의 민감도를 보여, 폐외 결핵만 있는 환자군(33.3%)나 두 가지 모두 이환된 군(47.4%)에 비하여 더 높은 민감도를 나타내었다(p=0.039). BioSign$^{TM}$TB를 이용한 경우, 환자군 43명 및 대조군 43 명에 대하여 74.4%의 민감도 및 95.3%의 특이도를 보였으며, 폐질환이 없는 환자군에서는 100%의 특이도를 나타내었다. 환자군중에서 초발환자 및 과거 폐결핵 병력이 있는 환자군 사이에는 민감도에 차이가 없었으며, 공동성 폐결핵 환자와 비공동성 폐결핵 환자사이에 검사상 민감도 차이는 통계적으로 유의하지 않았다(73.3% vs. 69.6%, p>0.05). 결 론: 혈청학적 방법의 하나인 immunochromatographic assay 기구는 높은 특이도와 양성 예측도를 보여 임상적 유용성이 기대되나, 상대적으로 낮은 민감도와 음성 예측도를 고려할 때, 단독 사용보다는 기존 방법과의 상보적 사용이 결핵진단에 더 도움이 될 것으로 생각된다. Background: Many diagnostic tests have developed to diagnose tuberculosis and other mycobacterial diseases but the diagnosis of tuberculosis relies largely on radiological findings and acid-fast staining of sputum and/or culture. Recently, new serologic diagnostic methods, which are safe and easy to use have been introduced into Korea. In this study, the usefulness of serologic diagnosis for tuberculosis and the disease pattern induced variation of the test were evaluated. Methods: Serological assay was performed upon 108 patients with two test kits, the ICT tuberculosis and the BioSign$^{TM}$TB, which are based upon a rapid immunochromatographic assay technique, capable of being interpreted within 15 minutes. The case groups consisted of 61 patients with active pulmonary tuberculosis(36 patients), extrapulmonary tuberculosis(3 patients), or both(22 patients). Control groups consisted of 47 patients with inactive old pulmonary tuberculosis(17 patients), nontuberculous pulmonary disease(16 patients) and nonpulmonary cardiac disease(14 patients). Results : The diagnostic sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of the ICT tuberculosis were 64.3%, 91.5%, 90.0% and 68.3% respectively. The diagnostic sensitivity, specificity, PPV and NPV of the BioSign$^{TM}$TB were 76.5%, 95.3%, 94.1 % and 78.8% respectively. Differences in sensitivity were not significant between patients with previous history of tuberculosis or patients without prior history of tuberculosis. The ICT tuberculosis test showed higher sensitivity in pulmonary tuberculosis patients(76.5%) than extrapulmonary tuberculosis patients(33.3%). There was no difference in sensitivity between patients with or without cavitary lesion by chest X-ray. Conclusion: Considering high specificity and PPV, serologic diagnosis using a rapid immunochromatographic assay device is another helpful diagnostic method in the diagnosis of tuberculosis, when combined with previous diagnostic methods such as chest X-ray, microbiologic study but it has limitation in terms of confirming the diagnosis for tuberculosis as the only diagnostic method because of relatively low sensitivity and NPV.

Anti-Tuberculosis Activity of Pediococcus acidilactici Isolated from Young Radish Kimchi against Mycobacterium tuberculosis

( Youjin Yoon ),( Hoonhee Seo ),( Sukyung Kim ),( Youngkyoung Lee ),( Md Abdur Rahim ),( Saebim Lee ),( Ho-yeon Song ) 한국미생물 · 생명공학회 2021 Journal of microbiology and biotechnology Vol.31 No.12

Tuberculosis is a highly contagious disease caused by Mycobacterium tuberculosis. It affects about 10 million people each year and is still one of the leading causes of death worldwide. About 2 to 3 billion people (equivalent to 1 in 3 people in the world) are infected with latent tuberculosis. Moreover, as the number of multidrug-resistant, extensively drug-resistant, and totally drug-resistant strains of M. tuberculosis continues to increase, there is an urgent need to develop new anti-tuberculosis drugs that are different from existing drugs to combat antibiotic-resistant M. tuberculosis. Against this background, we aimed to develop new anti-tuberculosis drugs using probiotics. Here, we report the anti-tuberculosis effect of Pediococcus acidilactici PMC202 isolated from young radish kimchi, a traditional Korean fermented food. Under coculture conditions, PMC202 inhibited the growth of M. tuberculosis. In addition, PMC202 inhibited the growth of drug-sensitive and -resistant M. tuberculosis- infected macrophages at a concentration that did not show cytotoxicity and showed a synergistic effect with isoniazid. In a 2-week, repeated oral administration toxicity study using mice, PMC202 did not cause weight change or specific clinical symptoms. Furthermore, the results of 16S rRNA-based metagenomics analysis confirmed that dysbiosis was not induced in bronchoalveolar lavage fluid after oral administration of PMC202. The anti-tuberculosis effect of PMC202 was found to be related to the reduction of nitric oxide. Our findings indicate that PMC202 could be used as an anti-tuberculosis drug candidate with the potential to replace current chemical-based drugs. However, more extensive toxicity, mechanism of action, and animal efficacy studies with clinical trials are needed.

Utility of Routine Culture for Tuberculosis from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in a Tuberculosis Endemic Country

( Ji Young Hong ),( Ji Ye Jung ),( Young Ae Kang ),( Byung Hoon Park ),( Won Jai Jung ),( Su Hwan Lee ),( Song Yee Kim ),( Sang Kook Lee ),( Kyung Soo Chung ),( Seon Cheol Park ),( Eun Young Kim ),( J 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.6

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.

Clinical Investigation of Cavitary Tuberculosis and Tuberculous Pneumonia

( Ki Man Lee ),( Kang Hyeon Choe ),( Sung Jin Kim ) 대한내과학회 2006 The Korean Journal of Internal Medicine Vol.21 No.4

Background: The radiographic characteristics of tuberculous pneumonia in adults are similar to primary tuberculosis that occurs in childhood, and upper lobe cavitary tuberculosis is the hallmark of postprimary tuberculosis. The purpose of this study was to investigate the factors associated with tuberculous pneumonia by making comparison with cavitary tuberculosis. Methods: The medical records and radiographic findings of patients with cavitary tuberculosis and tuberculous pneumonia, and who were diagnosed between March 2003 and February 2006, were analyzed retrospectively. Results: Forty patients had cavitary tuberculosis and sixteen patients had tuberculous pneumonia. Fever was more frequent for tuberculous pneumonia, whereas hemoptysis was more frequent for cavitary tuberculosis. The duration of symptoms before visiting the hospital was shorter, but the diagnosis after admission was more delayed for tuberculous pneumonia patients than for cavitary tuberculosis patients. The prevalence of underlying comorbidities such cancer, diabetes, alcoholism and long-term steroid use was not different between the two groups. The patients with tuberculous pneumonia were older and they had lower levels of serum albumin and hemoglobin than those with cavitary tuberculosis. The patients with tuberculous pneumonia showed a tendency to have more frequent endobronchial lesion. Tuberculous pneumonia occurred in any lobe, whereas the majority of cavitary tuberculosis patients had upper lung lesion, but the prevalence of lymphadenopathy, pleural effusion and previous tuberculosis scar was not different between the two groups. Conclusions: Older age, a lower level of serum albumin and hemoglobin and a random distribution of lesion were associated with tuberculosis pneumonia as compared with cavitary tuberculosis. These findings suggest that the pathogenesis of tuberculous pneumonia might be different from that of cavitary tuberculosis.

소아청소년 결핵의 진료 지침

최경민,김남희,김동호,김예진,김종현,오셩희,은병욱,이수영,이택진,전진경,홍정연 대한소아감염학회 2011 Pediatric Infection and Vaccine Vol.18 No.1

Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite the decrease in the incidence of tuberculosis in Korea, more than 30,000 new patients are diagnosed each year. Active tuberculosis is less frequent in children compared to adults but the risk of miliary tuberculosis and CNS tuberculosis is much higher. The diagnosis of tuberculosis in children and adolescents is difficult due to the nonspecific symptoms upon presentation. Diagnostic work up is based on the confirmation of tuberculosis infection by tuberculin skin test, abnormal radiologic findings, and contact with an adult with active tuberculosis. Anti-tuberculosis medications are prescribed according to the drug susceptibility of the index patient. Latent tuberculosis infection plays an important role in adult tuberculosis by reactivation. Thus, it is critical to accurately diagnose latent tuberculosis in children to prevent reactivation in adulthood. Korean guidelines for diagnosis and treatment of tuberculosis in children and adolescents provide evidence based recommendations in the optimal diagnosis and treatment for active and latent tuberculosis in children and adolescents based on the current Korean situation.

소아청소년에서 기관지 내시경을 통해 진단된 기관지 결핵의 임상 경과

서정민 ( Jung Min Suh ),조중범 ( Joong Bum Cho ),이정현 ( Jung Hyun Lee ),안강모 ( Kang Mo Ahn ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.2

목적: 소아청소년 폐결핵 환자에서 기관지 내시경을 일상적으로 사용하지 않지 때문에 소아청소년 폐결핵 환자에서 기관지 결핵의 발병률은 정확하게 알려져 있지 않다. 본연구에서는 기관지 내시경을 통해서 진단된 기관지 결핵 환자의 발병률과 임상 경과를 알아보고자 하였다. 방법: 1996년 1월부터 2011년 1월까지 삼성서울병원에서 폐결핵을 진단 받은 18세 미만의 환자 중에서 기관지 내시경을 통해 기관지 결핵을 진단 받은 환자를 대상으로 하였다. 의무 기록을 후향적으로 검토하여 성별, 나이, 결핵 피부 반응, 결핵 환자와 접촉 유무, 내원 당시의 주 호소 증상, 단순 흉부 방사선 검사 소견, 객담 혹은 위 흡인액 그리고 기관지 세척액의 미생물학적 검사 결과, 진단 시의 기관지 내시경 소견 및 추적 기관지 내시경 검사 소견 그리고 치료 결과를 조사하였다. 결과: 전체 101명의 폐결핵 환자 중에서 기관지 내시경을 통해 16명이 기관지 결핵으로 진단받았다. 이 중 여자가 9명(56.2%)였으며 진단 당시의 중앙 나이는 11.2세 (범위, 5개월-16.1세)였다. 결핵 환자와의 접촉력이 있었던 경우가 6명(37.5%)이었고, 투베르쿨린 반응 검사에서 양성을 보인 경우가 9명(56.2%)이었으며, 단순 흉부 방사선 촬영상 폐경화를 보인 경우가 7명(43.8%)으로 가장 많았다. 객담이나 위 흡인액으로 결핵균 검사를 시행한 12명 중에서, 항산균 도말 검사에서 4명(33.3%), 배양 검사와 중합 효소연쇄 반응 (polymerase chain reaction, PCR)검사는 각각 7명(58.3%)에서 양성 반응을 보였다. 기관지 세척액으로 결핵균 검사를 시행한 16명 중에서 항산균 도말 검사에서 7명(43.8%), 배양 검사는 8명(50%), 그리고 PCR 검사는 13명(81.3%)에서 양성 반응을 보였다. 기관지 내시경 소견에 따른 분류 상 건락성 괴사형이 7명(43.8%)으로 가장 많았다. 9명(56.3%)은 추적 관찰에서 기관지 협착을 보였으며, 4명(25%)은 폐 절제술을 받았다. 기관지 내시경 소견 상 섬유 협착형과 종양형이 건락성 괴사형에 비해서 기관지 폐쇄로 진행하는 경우가 더 많았다. 결론: 국내 소아청소년의 기관지 결핵 발병률은 폐결핵 환자의 15.8%였다. 기관지 결핵은 기관지 폐쇄의 합병증을 생기게 하여 수술적 치료까지 필요한 상황으로 이어질 수 있으므로, 합병증을 줄이기 위한 조기 진단과 적절한 치료가 필요할 것으로 사료된다. Purpose: The incidence of endobronchial tuberculosis in children is unknown, due to the inconsistent implementation of bronchoscopy in pediatric patients with pulmonary tuberculosis. In this study, our aim was to determine the incidence and clinical course of endobronchial tuberculosis in children. Methods: We performed a retrospective chart review of patients less than 18 years of age, who was diagnosed with endobronchial tuberculosis via fiberoptic bronchoscopy. Results: Out of the 101 patients with pulmonary tuberculosis, 16 patients had endobronchial tuberculosis. The median age at diagnosis was 11.2 years (range, 5 months to 16.1 years). Tuberculin skin test was positive in 9 cases (56.2%), and 6 patients (37.5%) had a history of household contact with tuberculosis. Consolidation lesion was common in the simple chest radiographs of patients with endobronchial tuberculosis. According to the bronchoscopic finding, actively caseating type was most common (43.8%). Nine of the 16 patients of endobronchial tuberculosis progressed to bronchial obstruction and 4 patients underwent pneumonectomy or lobectomy. Fibrostenotic and tumorous type tend to progress to endobronchial obstruction compared with actively caseating type. Conclusion: The incidence of endobronchial tuberculosis in pediatric pulmonary tuberculosis was 15.8%. Early detection and effective treatment of endobronchial tuberculosis are important to decrease the secondary complication, such as bronchial obstruction.

비결핵항산균증 전국 실태조사

대한결핵 및 호흡기학회 학술위원회 대한결핵및호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.3

Background: The prevalence of tuberculosis in Korea decreased remarkably for the past 30 years, while the incidence of disease caused by mycobacteria other than tuberculosis is unknown. Korean Academy of Tuberculosis and Respiratory Diseases performed national survey to estimate the incidence of mycobacterial diseases other than tuberculosis in Korea. We analyzed the clinical data of confirmed cases for the practice of primary care physicians and pulmonary specialists. Methods: The period of study was from January 1981 to October 1994. We collected the data retrospectively by correspondence with physicians in the hospitals that referred the specimens to Korean Institute of Tuberculosis, The Korean National Tuberculosis Association for the detection of mycobacteria other than tuberculosis. In confirmed cases, we obtained the records for clinical, laboratory and radiological findings in detail using protocols. Results: 1) Mycobacterial diseases other than tuberculosis were confirmed that 1 case was in 1981, 2 cases in 1982, 4 cases in 1983, 2 cases in 1984, 5 cases in 1985, 1 case in 1986, 3 cases in 1987, 1 case in 1988, 6 cases in 1989, 9 cases in 1990, 14 cases in 1990, 10 cases in 1992, 4 cases in 1993, and 96 cases in 1994. Cases since 1990 were 133 cases(84.2%) of a total. 2) Fifty seven percent of patients were in the age group of over 60 years. The ratio of male to female patients was 2.6:1. 3) The distribution of hospitals in Korea showed that 61 cases(38.6%) were referred from Double Cross Clinic, 42 cases(26.6%) from health centers, 21 cases(13.3%) from tertiary referral hospitals, 15 cases(9.5%) from secondary referral hospitals, and 10 cases(6.3%) from primary care hospitals. The area distribution in Korea revealed that 98 cases(62%) were in Seoul, 17 cases(10.8%) in Gyeongsangbuk-do, 12 cases(7.6%) in Kyongki-do, 8 cases(5.1%) in Chungchongnam-do, each 5 cases(3.2%) in Gyeongsangnam-do and Chungchongbuk-do, 6 cases(3.8%) in other areas. 4) In the species of isolated mycobacteria other than tuberculosis, M. avium-intracellulare was found in 104 cases(65.2%), M. fortuitum in 20 cases(12.7%), M. chelonae in 15 cases(9.5%), M. gordonae in 7 cases(4.4%), M. terrae in 5 cases(3.2%), M. scrofulaceum in 3 cases(1.9%), M. kansasii and M. szulgai in each 2 cases(1.3%), and M. avium-intracellulare coexisting with M. terrae in 1 case(0.6%). 5) In pre-existing pulmonary diseases, pulmonary tuberculosis was 113 cases(71.5%), bronchiectasis 6 cases(3.8%), chronic bronchitis 10 cases(6.3%), and pulmonary fibrosis 6 cases(3.8%). The timing of diagnosis as having pulmonary tuberculosis was within 1 year in 7 cases(6.2%), 2~5 years ago in 32 cases(28.3%), 6~10 years ago in 29 cases(25.7%), 11~15 years ago in 16 cases(14.2%), 16~20 years ago in 15 cases (13.3%), and 20 years ago in 14 cases(12.4%). Duration of anti-tuberculous treatment was within 3 months in 6 cases(5.3%), 4~6 months in 17 cases(15%), 7~9 months in 16 cases(14.2%), 10~12 months in 11 cases(9.7%), 1~2 years in 21 cases(18.6%), and over 2 years in 8 cases(7.1%). The results of treatment were cure in 44 cases(27.9%) and failure in 25 cases(15.8%). 6) Associated extra-pulmonary diseases were chronic liver disease coexisting with chronic renal failure in 1 case(0.6%), diabetes mellitus in 9 cases(5.7%), cardiovascular diseases in 2 cases(1.3%), long-term therapy with steroid in 2 cases(1.3%) and chronic liver disease, chronic renal failure, colitis and pneumoconiosis in each 1 case(0.6%). 7) The clinical presentations of mycobacterial diseases other than tuberculosis were 86 cases (54.4%) of chronic pulmonary infections, 1 case(0.6%) of cervical or other site lymphadenitis, 3 cases(1.9%) of endobronchial tuberculosis, and 1 case(0.6%) of intestinal tuberculosis. 8) The symptoms of patients were cough(62%), sputum(61.4%), dyspnea(30.4%), hemoptysis or blood-tinged sputum(20.9%), weight loss(13.3%), fever(6.3%), and others(4.4%). 9) Smear negative with culture negative case 연구 배경: 우리나라에서 과거 30년 동안 결핵 유병률은 현저히 감소되어 왔으나 비결핵항산균에 의한 질병의 발생빈도는 아직 정확하게 알려져 있지 않다. 대한결핵 및 호흡기학회는 전국 실태조사를 통하여 현재까지 확인된 전국의 비결핵항산균증 발생 현황을 파악하고 이를 분석하여 외국의 보고와 비교함으로써 일반 개업의 및 내과 전문의의 진료 활동에 도움이 되도록 하고자 본 사업을 시행하였다. 방법: 조사와 분석은 1981년 1월부터 1994년 10월까지 대한결핵협회 결핵연구원에 의뢰된 검체중 비결핵항산균의 종(species)이 확인된 158예를 대상으로 검사를 의뢰한 병원의 진료의에게 증례 기록지를 보내어 정확한 임상 및 검사 정보를 기록하여 회신 하도록하는 후향적 조사 방법으로 그 결과를 수집 분석하였다. 결과: 1) 연도별로 보면 1981년에 1예, 1982년 2예 등으로 1990년 이전에는 매년 10예 미만 이던 것이 1991년에 14예, 1992년 10예, 1993년 4예, 1994년에는 96예로 1990년 이후가 전체의 84.2%를 차지하였다. 2) 연령은 10대 1예, 20대 6예, 30대 15예, 40대 19예, 50대 27예, 60대 51예, 70세 이상 39예로 60세 이상이 전체의 57%를 차지하였다 성별 분포는 남자 114예(72.1%), 여자 44예(27.9%) 이었다. 3) 병원별 분포는 복십자의원 61예(38.6%), 보건소 42예(26.6%), 3차기관 21예(13.3%), 2차기관 15예(9.5%), 1차기관 10예(6.3%) 이었으며, 지역별 분포는 서울 98예(62%), 경상북도 17예(10.8%), 경기도 12예(7.6%), 충청남도 8예(5.1%), 경상남도와 충청북도 각각 5예(3.2%), 기타 지역이 6예(3.8%) 이었다. 4) 선행 폐 질환은 폐결핵 113예(71.5%), 기관지확장증 6예(3.8%), 만성 기관지염 10예(6.3%), 폐섬유증 6예(3.8%) 등이었다. 폐결핵의 발병 시기는 1년 이내가 7예(6.2%), 2~5년전 32 예(28.3%), 6~10년전 29예(25.7% ) 등으로 2~10년전이 전체의 54%를 차지하였다. 폐결핵의 치료 기간은 3개월 이내가 6예로 5.3%이었으며, 4~6개월이 17예(15%), 7~9개월 16예(14.2%), 10~12 개월 11예(9.7%), 1~2년 21예(18.6%), 2년 이상 8예로 7.1% 이었다. 폐결핵의 치료 결과는 완치가 44예(38.9%), 치료 설패가 25예(22.1%) 이었다. 5) 동반된 폐외질환은 만성 간질환과 만성 산부전이 함께 있었던 경우 각각 1예를 포함하여 당뇨병이 9예(5.7%)에서 있었으며, 심혈관계질환 2예(1.3%), 장기간 스테로이드를 투여 받은 경우 2예(1.3%) 그리고 만성 간질환, 만성 신부전, 대장염 및 진폐증이 각 1예(0.6%)씩 있었다. 6) 비결핵항산균증이 발현한 임상상은 만성 폐 감염증 86예(54.4%), 경부 및 기타 임파선염 1예(0.6%), 기관지 결핵 3예(1.9%), 장결핵 1예(0.6%) 이었다. 7) 임상 소견은 기침 62%, 객담 61.4%, 호흡곤란 30.4%, 객혈 및 혈담 20.9%, 체중 감소 l3.3%, 발열 6.3%, 기타 4.4% 등 이었다. 8) 흉부 X-선 소견은 정상 7예(4.4%), 경증 20예(12.7%), 중등증 67예(42.4%), 중증 47예(29.8%)이었으며, 공동은 43예(27.2%)에서 동반되었고, 흉막염은 18예(11.4%)에서 동반되었다. 9) 비결핵항산균이 확언된 검사물은 객담 143예(90.5%), 객담 및 기관지세척액 4예(2.5%), 기관지세척액 1예(0.6%) 이었다. 동정된 비결핵항산균의 종류는 M. avium-intracellulare가 104예로 전체의 65.2%를 차지하였고 M. fortuitum 20예(12.7%), M. chelonae 15예(9.5%), M. gordonae 7예(4.4%), M. terrae 5예(3.2%), M. scrofulaceum 3예(1.9%), M. kansasii와 M. szulgai가 각각 2예(1.3%), 그리고 M. avium-intracellulare와 M. terrae가 동시에 확인된 경우가 1예(0.6%) 이었다. 10) 도말 및 배양 검사 결과는 4번의 검사 중 도말 음성, 배양 양성인 경우는 첫번째 검사상 59