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*

Tuberculosis (TB) is one of the largest health problems in the world today. And the incidence of nontuberculous mycobacteria (NTM) lung disease appears to be increasing worldwide. Recently, an automated, nucleic acid amplification assay for the rapid detection of both Mycobacterium tuberculosis and rifampin resistance was developed (Xpert MTB/RIF). And fixed-dose combinations of anti-TB drugs and linezolid have been introduced in the treatment of TB. And new NTM species, named Mycobacterium massiliense, which is very closely related to Mycobacterium abscessus was reported. In this review, these recent advances in the diagnosis and treatment of TB and clinical characteristics of M. massiliense lung disease are discussed.
Acetamides ; Incidence ; Lung ; Lung Diseases ; Mycobacterium ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Nucleic Acid Amplification Techniques ; Oxazolidinones ; Rifampin ; Tuberculosis ; Linezolid

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

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

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

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

As the prevalence of tuberculosis declines, the proportion of nontuberculous mycobacterial (NTM) lung disease is increasing in Korea. The combined use of liquid and solid media increases the sensitivity of mycobacterial culture and shortens culture time. Because NTMs are ubiquitous in the environment, NTM lung disease requires strict diagnostic criteria to prevent over-diagnosis of NTM lung disease. Mycobacterium avium complex is the most common pathogen of NTM lung disease in Korea and present in two forms: upper lobe cavitary and nodular bronchiectatic form. Decision of treatment of NTM lung disease depends on the infecting species and overall condition of the patient. Because medical therapy requires the use of multiple drugs over 18 to 24 months, surgery for localized disease may be useful for those species refractory to medical therapy.
Culture Media ; Humans ; Korea ; Lung Diseases ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection ; Nontuberculous Mycobacteria ; Prevalence ; Tuberculosis

As the prevalence of tuberculosis declines, the proportion of nontuberculous mycobacterial (NTM) lung disease is increasing in Korea. The combined use of liquid and solid media increases the sensitivity of mycobacterial culture and shortens culture time. Because NTMs are ubiquitous in the environment, NTM lung disease requires strict diagnostic criteria to prevent over-diagnosis of NTM lung disease. Mycobacterium avium complex is the most common pathogen of NTM lung disease in Korea and present in two forms: upper lobe cavitary and nodular bronchiectatic form. Decision of treatment of NTM lung disease depends on the infecting species and overall condition of the patient. Because medical therapy requires the use of multiple drugs over 18 to 24 months, surgery for localized disease may be useful for those species refractory to medical therapy.
Culture Media ; Humans ; Korea ; Lung Diseases ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection ; Nontuberculous Mycobacteria ; Prevalence ; Tuberculosis

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*