PURPOSE: It is difficult to determine the activity of tuberculosis radiologically. Therefore there have been efforts to assess the activity using radiopharmaceuticals such as 67Ga, 99mTc-tetrofosmin, and 99mTc-MIBI. But there may be some discrepancy in defining the term 'activity' between clinicians and nuclear physicians. While negative conversion of sputum acid fast bacilli (AFB) is defined as 'disappearance of activity' by clinicians, a loss of uptake in previously positive lesion is accepted as 'disappearance of activity' by nuclear physicians. We designed a prospective study to see if the negative conversion of sputum AFB could directly match the disappearance of radioactivity of the lesion. MATERALS AND METHODS: Fifteen patients with bacteriologically confirmed active localized pulmonary tuberculosis were scanned 10 and 60 min after intravenous injection of 550 MBq 99mTc-MIBI. In 6 patients, who showed negative conversion of sputum AFB after 3-7 months of chemotherapy, 99mTc-MIBI scan was repeated. For the purpose of comparison, target/nontarget ratios of the lesions were determined. RESULTS: 12/15 (80%) patients with active pulmonary tuberculosis showed increased uptake of 99mTc-MIBI in tuberculous lesion. After negative conversion of sputum AFB, 5/6 (83%) patients still showed increased uptake, although the intensity of uptake decreased. CONCLUSION: Uptake of radioactivity decreased but did not disappear after negative conversion of sputum AFB. 99mTc-MIBI scan may be useful to address the degree of inflammation of pulmonary tuberculous lesion, but the uptake did not directly match the activity defined by positivity of sputum AFB. We nuclear physicians might have used the term 'activity' somewhat differently from clinicians who treat patients with tuberculosis.
Drug Therapy ; Humans ; Inflammation ; Injections, Intravenous ; Prospective Studies ; Radioactivity ; Radiopharmaceuticals ; Sputum ; Tuberculosis* ; Tuberculosis, Pulmonary*

BACKGROUND: Induced sputum (IS) has been used to collect airway secretions in subjects who have inadequate sputum production. The aim of this study was to investigate the efficacy of IS for the diagnosis of pulmonary tuberculosis (PTB) in adults unable to expectorate sputum. METHODS: Medical records of 39 PTB patients who underwent IS due to absence of spontaneous sputum production between January 2011 and March 2014 at a tertiary hospital in South Korea were reviewed. Results of acid fast bacilli smear, Mycobacterium tuberculosis culture and polymerase chain reaction assay for M. tuberculosis (TB-PCR) of IS specimens from these patients were analyzed. Clinical and high-resolution computed tomography (HRCT) characteristics were also analyzed to find characteristics associated with IS culture positivity. RESULTS: Of the 39 IS specimens from PTB patients, 7 (17.9%) were smear positive and 31 (79.5%) were culture positive. Twenty-four IS specimens were tested for TB-PCR and 13 (54.2%) were positive on TB-PCR. Multivariate analysis showed that younger age (p=0.04) and presence of tree-in-bud appearance on HRCT (p=0.03) were independent predictors of IS culture positivity. CONCLUSION: IS is useful for the diagnosis of PTB in adults unable to expectorate sputum. Younger age and tree-in-bud appearance on HRCT were associated with IS culture positivity in these patients.
Adult* ; Diagnosis* ; Humans ; Korea ; Medical Records ; Methods ; Multivariate Analysis ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Sputum* ; Tertiary Care Centers ; Tuberculosis ; Tuberculosis, Pulmonary*

BACKGROUND: Stopping medical treatment by tuberculosis (TB) patients prior to completing treatment period is a major concern in private hospitals. We evaluated the impact of public-private mix (PPM) project on increasing treatment success rate of TB in a private tertiary hospital in Korea. METHODS: Starting in February 2009, TB patients treated at Dankook University Hospital received health education and case monitoring activities by specially trained public health nurses (PPM project). On a retrospective basis, we reviewed medical records and compared the treatment outcome of TB patients treated under the PPM project (PPM group) to patients treated without the PPM project (control group) between January 2008 and June 2010. In addition, we also evaluated the risk factors treatment non-completion. RESULTS: The number of patients in the PPM group and control group were 123 (85 pulmonary TB and 38 extrapulmonary TB) and 146 (101 pulmonary TB and 45 extra-pulmonary TB), respectively. The PPM group had demographic and clinical findings comparable to those of control group. The PPM group showed a significantly higher treatment success rate (93.5%) compared to the control group (77.9%). However, development of complications, proximity to the hospital, and presence of co-morbid disease did not influence the treatment success rate. CONCLUSION: The PPM project was effective at increasing the TB treatment success rate. An effort to improve and to expand the PPM project is needed in private Korean hospitals.
Health Education ; Hospitals, Private ; Humans ; Medical Records ; Private Sector ; Public Health Nursing ; Public Sector ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Treatment Outcome ; Tuberculosis

BACKGROUND: Open lung biopsy(OLB) has conventionally been regarded as the gold standard for the diagnosis in interstitial lung disease. With recent advances in diagnostic technique such as high resolution computed tomography(HRCT), and transbronchial lung biopsy(TBLB) which provide relatively accurate diagnosis of ILD, it is necessary to reevaluate the role of these methods in the diagnosis of ILD. METHODS: We carried out a retrospective analysis of nineteen patients who underwent OLB at Dankook University Hospital for the diagnosis of acute and chronic ILD, between May 1995 and June 1998. By reviewing the medical records, the demographic findings, underlying conditions, HRCT and TBLB findings, OLB diagnosis, therapy after OLB, and complication of OLB were evaluated. RESULTS: 1) Thirteen patients(68.4%) had chronic ILD(symptom duration over 2 weeks prior to OLB), and six patients(31.6%) had acute ILD(symptom duration less than 2 weeks). 2) Specific diagnosis were reached in 92%(12/13) of chronic ILD(5 Bronchiolitis obliterans organizing pneumonia(BOOP), 2 constrictive bronchiolitis, 3 Usual interstitial pneumonia, 1 hypersensitivity pneumonitis, 1 eosinophilic pneumonia), and in all patients of acute ILD(5 acute interstitial pneumonia, 1 pneumocystis carinii pneumonia). 3) HRCT were performed in all patients and a correct first choice diagnosis rate of HRCT was 42%(5/12) in chronic ILD. 4) In chronic ILD patients, 62%(8/13) received specific therapy(steroid therapy in 7 patients and moving in one patient), after OLB, but in acute ILD, all patients received specific therapy(steroid therapy in 5 patients and steroid and antibiotic therapy in one patient) after OLB. 5) The in-hospital mortality after OLB was 5.3%(1/19). CONCLUSION: OLB is an excellent diagnostic technique with relatively low complications in patients with ILD. Therefore OLB should be considered in patients with ILD when the specific diagnosis is important for the treatment, especially in patients with acute ILD.
Alveolitis, Extrinsic Allergic ; Biopsy* ; Bronchiolitis Obliterans ; Diagnosis* ; Eosinophils ; Hospital Mortality ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases, Interstitial* ; Lung* ; Medical Records ; Pneumocystis carinii ; Retrospective Studies

Although the incidence of tuberculosis has declined dramatically recently, tuberculosis is still one of the great public health problems in South Korea. Older persons are more susceptible to tuberculosis than younger persons. Older pulmonary tuberculosis patients may have few symptoms and atypical radiographic findings, so clinicians need to have high index of suspicion to make a diagnosis of pulmonary tuberculosis. The basic approach to treatment of tuberculosis in elderly is the same as in younger patients. Standard chemotherapy of drug susceptible tuberculosis consists of a 2-months intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4-months maintenance phase (isoniazid, rifampin, ethambutol). Vitamin B6 (pyridoxine) is usually given to prevent isoniazid induced peripheral neuropathy which is more common in elderly patients. Older tuberculosis patients are more susceptible to adverse effects of anti-tuberculosis drugs. Monitor liver function and educate elderly patients and their family members about the signs and symptoms of adverse drug reactions and encourage to report promptly to their physician any of adverse drug reactions. Compliance to treatment of elderly tuberculosis patients is poor due to frequent co-morbid conditions and low socioeconomic conditions. Public-private collaboration will improve the compliance of elderly tuberculosis patients managed in private hospitals.
Aged ; Compliance ; Cooperative Behavior ; Drug Toxicity ; Ethambutol ; Humans ; Incidence ; Isoniazid ; Liver ; Organothiophosphorus Compounds ; Peripheral Nervous System Diseases ; Public Health ; Republic of Korea ; Rifampin ; Tuberculosis ; Tuberculosis, Pulmonary ; Vitamin B 6

BACKGROUND: IL-8 is a potent chemotactic cytokine that plays an important role in the host defense mechanism against M. tuberculosis by recruiting inflammatory cells to the site of the infection. Lung epithelial cells, as well as alveolar macrophages are known to preduce IL-8 in response to M. tuberculosis. IL-8 gene expression is mainly regulated on the level of transcription by NF-κB. This study investigated whether or not A549 cells produce IL-8 in NF-κB dependent mechanism in response to macrophages phagocytosing M. tubersulosis. METHODS: Peripheral blood monocytes that were obtained from healthy donors were cultured for 24 h with M. tuberculosis and a conditioned medium(CoMTB) was obtained. As a negative control, the conditioned medium without M. tuberculosis (CoMCont) was used. A549 cells were stimulated with M. tuberculosis, CoMCont and CoMTB and the IL-8 concentration in the culture media was measured by ELISA. The CoMTB induced IL-8 mRNA expression in the A549 cells was evaluated using RT-PCR, and CoMTB induced IκBα degradation was measured using western blot analysis. CoMTB induced nuclear translocation and DNA binding of NF-κB was also examined using an electrophoretic mobility shift assay(EMSA), and the CoMTB induced NF-κB dependent IL-8 transcriptional activity was measured using a luciferase reporter gene assay. RESULTS: CoMTB induced IL-8 production by A549 cells(46.8±4.8 ng/ml) was higher than with direct stimulation with M. tuberculosis (6.8±2.9 ng/ml). CoMTB induced IL-8 mRNA expression increased after 2 h of stimulation and was sustained for 24 h. IκBα was degraded after 10 min of CoMTB stimulation and reappeared by 60 min. CoMTB stimulated the nuclear translocation and DNA binding of NF-κB. The CoMTB induced NF-κB dependent IL-8 transcriptional activity(13.6±4.3 times control) was higher than either CoMCont(2.0±0.6 times control) or M. tuberculosis (1.4±0.6 times control). CONCLUSION: A conditioned medium of peripheral blood monocytes phagocytosing M. tuberculosis stimulates NF-κB dependent IL-8 production by the lung epithelial cells.
Blotting, Western ; Culture Media ; Culture Media, Conditioned ; DNA ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Gene Expression ; Genes, Reporter ; Humans ; Interleukin-8* ; Luciferases ; Lung* ; Macrophages ; Macrophages, Alveolar ; Monocytes* ; Mycobacterium tuberculosis* ; Mycobacterium* ; RNA, Messenger ; Tissue Donors ; Tuberculosis

Tuberculosis (TB) is prevalent and remains a major public health problem in South Korea. Joint committee for the development of Korean guidelines for TB has published a guideline for the treatment of TB recently. The aim of this guideline is to provide evidence based practical recommendations to clinicians caring TB patients in South Korea. Treatment regimen for the newly diagnosed TB is divided into 2 months of initial intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4 months of maintenance phase (isoniazid, rifampin, ethambutol). Ethambutol may be dropped from the regimen after 2 months of treatment if bacilli is susceptible to isoniazid and rifampin (2HREZ/4HR). Because stopping medical treatment by the patient is most serious problem in the treatment of TB, this guideline emphasizes education and supervision of the patients to ensure patient's adherence to taking medicines.
Dietary Sucrose ; Ethambutol ; Humans ; Isoniazid ; Joints ; Organization and Administration ; Public Health ; Republic of Korea ; Rifampin ; Tuberculosis

BACKGROUND/AIMS: Delayed diagnosis and treatment of pulmonary tuberculosis (TB) can result in progressive disease and contribute to the spread of TB. Presenting symptoms and factors associated with delayed diagnosis of pulmonary TB were evaluated in a tertiary university hospital in South Korea. METHODS: Patients with pulmonary TB diagnosed from July 2011 to July 2012 were interviewed with questionnaires regarding symptoms of pulmonary TB and the type of health care facilities first visited. Medical records were also reviewed to evaluate the extent of diagnostic delay and factors associated with delayed diagnosis. RESULTS: Of 107 patients with pulmonary TB, 85 (79.4%) were diagnosed after visiting doctors for evaluation of pulmonary TB symptoms and 22 (20.6%) were diagnosed after medical check-ups. Among patients diagnosed with pulmonary TB symptoms, the mean patient delay (time from symptom onset to initial doctor visit) was 16.7 +/- 15.1 days, and the mean doctor delay (time from initial doctor visit to diagnosis of pulmonary TB) was 22.2 +/- 21.3 days. First visit to a drugstore was associated with longer patient delays (hazard ratio [HR], 2.533; 95% confidence interval [CI], 1.424-4.506). First visit to a primary clinic was associated with longer doctor delays compared with first visit to a public health center or secondary/tertiary hospital (HR, 1.767; 95% CI, 1.003-3.114). The presence of hemoptysis was associated with shorter doctor delays (HR, 0.438; 95% CI, 0.203-0.944). CONCLUSIONS: To reduce delays in diagnosis of pulmonary TB, patients should be educated to quickly consult with a doctor when they have symptoms of pulmonary TB, and primary clinic doctors should be educated to maintain a high index of suspicion for pulmonary TB.
Delayed Diagnosis ; Delivery of Health Care ; Hemoptysis ; Humans ; Medical Records ; Public Health ; Surveys and Questionnaires ; Tuberculosis ; Tuberculosis, Pulmonary

Tuberculosis (TB) remains a major public health problem in South Korea. The Joint Committee for the Development of Korean Guidelines for Tuberculosis published the Korean Guidelines for Tuberculosis in 2011 to provide evidence-based practical recommendations to health care workers caring for patients with TB in South Korea. After reviewing recent national and international scientific data on TB, the committee updated the Korean guidelines for TB in 2014. This article presents some practical issues related to the 2014 updated guidelines: namely use of the Mycobacterium tuberculosis - polymerase chain reaction assay and the Xpert MTB/RIF assay in the diagnosis of TB, as well as medical treatment for patients with multidrug-resistant TB.
Delivery of Health Care ; Diagnosis ; Humans ; Joints ; Korea ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Public Health ; Tuberculosis* ; Tuberculosis, Multidrug-Resistant

Multidrug-resistant tuberculosis(MDR-TB), resistant to at least the two main TB drugsisoniazid and rifampicin, has been a threat to TB control because the treatment requires more toxic drugs and longer period with poor treatment outcomes. Recently, more serious concerns have been raised about extensively drug resistant-tuberculosis (XDR-TB), which shows resistance to fluoroquinolones and aminoglycosides in addition to isoniazid and rifampicin. XDR-TB is a serious global health threat because the cure is very difficult as few sensitive anti-TB drugs remain. XDR-TB develops when first-and second-line anti-TB drugs are misused during the course of treatment, most commonly due to poor compliance of the patients to the treatment regimen. People with XDR-TB can pass the XDR-TB bacteria to other people. Thus, every effort should be made to prevent the development of XDR-TB by establishing an effective TB control program maximizing patient adherence to prescribed anti-TB regimen and minimizing contact of XDR-TB patients with other people to prevent the spread of XDR-TB.
Aminoglycosides ; Bacteria ; Compliance ; Extensively Drug-Resistant Tuberculosis ; Fluoroquinolones ; Humans ; Isoniazid ; Patient Compliance ; Rifampin ; Tuberculosis