BACKGROUN: Many studies have shown that diabetes mellitus does not modify the clinical features and treatment outcomes. However, to our knowledge, those surveys for clinical features and treatment outcomes in pulmonary tuberculosis with diabetics were performed 15 years ago and have not been confirmed by more recent reports. Therefore, the purpose of this study is to investigate the effect of diabetes mellitus on microbiologic findings in far advanced stage of pulmonary tuberculosis and so to make some suggestions for the management of pulmonary tuberculosis with diabetes mellitus. METHODS: This study population was composed of 47 patients with far advanced stage of culture-proven pulmonary tuberculosis hospitalized in our department from 2000 through 2002. None of patients was intractable. Patients were divided into 4 groups; group1;nondiabetics with initial treatment, group2;diabetics with initial treatment, group3;nondiabetics with retreatment, group4; diabetics with retreatment. Treatment regimens were individualized on the basis of susceptibility results. A retrospective review of the records of all 47 patients with pulmonary tuberculosis and diabetes mellitus was carried out. The clinical features, bacteriologic, radiographic findings and treatment outcomes were compared among 4 groups. RESULTS: Time to negative conversion of AFB in sputum smear was significantly increased in diabetics group than nondiabetics, but time to negative conversion of AFB in sputum culture was not significant. Also time to negative conversion of AFB in sputum smear or culture was not affected by treatment pattern. The effect of antituberculosis medication significantly delayed response in diabetics with retreatment and resistance rate was higher in diabetics or retreatment. Time to negative conversion of AFB in sputum smear was related to cavitary size in radiographic findings, but time to negative conversion of AFB in sputum culture was related to drug sensitivity. Natural course of cavity on radiographic findings after antituberculosis therapy was not significant. CONCLUSION: It seems that diabetes mellitus does not affect bacteriological negative conversion rates except negative conversion rate of AFB in sputum smear, which chiefly related to cavitary size, in far advanced stage of pulmonary tuberculosis. Therefore, because the presence of AFB in sputum smear after 5th months of therapy is not necessarily a treatment failure in far advanced stage of pulmonary tuberculosis with diabetics, any decision regarding prologation or change in therapy maybe required based on the results of culture and drug susceptibility tests.
Bacteriology ; Diabetes Mellitus* ; Humans ; Retreatment ; Retrospective Studies ; Sputum ; Treatment Failure ; Treatment Outcome ; Tuberculosis, Pulmonary*

BACKGROUND: The extraction methods of DNA from clinical samples are the major obstacle to use the PCR(Polymerase Chain Reaction) in routine labortary for early detection of M. tuberculosis. We tried to improve the extraction method of DNA from sputum for establishment of the PCR in routine labortary by reducing the possibility of cross contamination and performing it easily and safely. METHODS: We used the InstaGene(TM) DNA extraction kit(BioRad Co.) using Chelex 100 ion exchange resin for preparation of DNA. We compared InstaGene method in 100 cases of sputum from proteinase K method which is known as the most commonly used method for DNA purification(Experiment 1). And we compared InstaGene method in 98 cases of sputum from Microwave method developed by a company in Korea(Experiment 2). In experiment 1, 245bps of IS6110 were amplified and then 188bps were amplified by nested PCR. In experiment 2, 536bps in primary PCR and 276bps in nested PCR were amplified and analysed by agarose gel electrophoresis and EtBr staining. RESULTS: When we chose AFB smear, culture, or AFB smear and culture as a standard test, PCR had low specificity and positive predictive value in both experiments. The InstaGene method has higher value in sensitivity and negative predictive value significantly than proteinase K method. The InstaGene method and the Microwave methods were similar in sensitivity, specificity, positive predictive value and negative predictive value.. CONCLUSION: Even though both methods had lower possibility of cross contamination, shorter time requrirement, simplicity, and economic advantages than Proteinase K method, the InstaGene method was a little simpler than the Microwave method. Therefore, in terms of usfulness in clinical application, the Instagene method seems to be the most useful method in DNA extraction for detection of M. tuberculosis using PCR. The reliability of this method will be clarified by further studies with enough clinical samples.
DNA* ; Electrophoresis, Agar Gel ; Endopeptidase K ; Ion Exchange* ; Microwaves ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Sputum ; Tuberculosis*

In this study, we investigated profiles of the cytokines IFN-g, IL-12, and IL-10 in active pulmonary tuberculosis (EAPTB) patients, HIV-negative patients with multidrug-resistant tuberculosis (MDR-TB) and in healthy tuberculin reactors (HTR). We studied the responses of peripheral blood mononuclear cells (PBMC) from 12 EAPTB patients and 15 MDR-TB patients to stimulation with a purified protein derivatives (PPD) antigen (Ag), and compared them with those from 14 HTR. Using ELISA, IFN-g production was found to be significantly depressed, while IL-10 was significantly elevated in both MDR-TB and EAPTB after in vitro stimulation with PPD, compared with those in HTR. Although there was no significant difference in IL-12 production among the three groups, mean IL-12 production was highest in patients with MDR-TB. In these patients, IL-12 production was significantly correlated with IL-10 expression, but not IFN-g production. In addition, neutralization of endogenous IL-10 led to enhanced IFN-g and IL-12Rb2 mRNA expression in TB patients. Our findings suggest that both groups of TB patients may have a similar disregulated pattern of IL-12, IL-10, and IFN-g production during M. tuberculosis infection. Furthermore, the results suggest a potentially pathogenic role for IL-10 in impaired Th1 immune responses in TB patients.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interferon-gamma ; Interleukin-10* ; Interleukin-12* ; Mycobacterium tuberculosis ; RNA, Messenger ; Tuberculin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant* ; Tuberculosis, Pulmonary