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Mycobacterium Avium - in tracellulare Complex 와 M . Fortuitum 에 의한 폐항산균증(肺抗酸菌症) 3예
김상재,홍수표,배길한,김성진,진병환,정충모 대한미생물학회 1982 大韓微生物學會誌 Vol.17 No.1
Two cases of pulmonary disease in a 54 year-old female and a 70 year-old male patient due to Mycobacterium avium-intracellulare complex (MAIC) and a case of pulmonary infection in a 69 year-old male patient due to M fortuitum (MF) were found recently in this institute. All three patients bad a long history of anti-tuberculous chemotherapy because they were initially diagnosed as pulmonary tuberculosis. A 70 year-old male patient infected with MAIC had an unsuccessful chemotherapy history of isoniazid (INH), para-aminosalicylic acid (PAS) and streptomycin (SM) with an incomplete, temporary, symptomatic improvement, for three years since 1964 when he was first diagnosed as pulmonary tuberculosis on physical examination. A 54 year-old female patient infected with MAIC also had an unsuccessful chemotherapy history with the various anti-tuberculous drugs since 1958. Both patients discharged large number of MAIC in their sputum specimens for at least more than one year, but no M tuberculosis at all. A 69 year-old male patient infected with MF was diagnosed as moderately advanced pulmonary tuberculsis in 1977. Combined chemotherapy with INH+PAS+pyrazinamide (PZA) improved his clinical symptoms, however, his chest radiograph was deteriorated again in 1980 one year after he stopped therapy. Therefore he started chemotherapy again with INH+ethionamide (TH)+cycloserine(CS) but no improvement was noticed. MF was cultured from his sputum in August 1983 and he continuously discharged the same baeilli until last examination of January l982. Whether all three patients were initially infected with nontuberculous mycobacteria or complicated with predisposing tuberculosis was not clear because there were no reliable bacteriological Examination records.
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Report of Four Cases of Pulmonary Pseudallescheriasis from Korea
김상재,홍영표,김신옥,윤영자,Kim, Sang-Jae,Hong, Young-Pyo,Kim, Sin-Ok,Yoon, Young-Ja The Korea Society for Microbiology 1983 大韓微生物學會誌 Vol.18 No.1
저자 등은 결핵으로 인해 생긴 공동을 가진 4명의 남자 환자에 있어서 성공적인 결핵화학요법으로 결핵은 치유되어 객담검사에서 결핵균은 더이상 검출되지 않았으나, 계속되는 각혈로 진균검사를 실시한 결과 Pseudallerscheria boydii(불완전세대 Scedosporium apiospermum)에 의한 진균종(眞菌腫)임이 밝혀졌다. 여러 차례의 객담검사로부터 6개월 또는 2년 이상 계속 동일한 균종이 불리 배양되었고 그리고 그들의 혈청은 P. boydii 배양여액 항원과 immunodiffusion test를 실시한 결과 precipitin bands를 형성하였다. 4환자의 흉부 X-선 사진상에는 뚜렷한 진균종음영을 볼 수 없었다. 2명의 환자 객담에서는 P. boydii와 더불어 Candida albicans와 Aspergillus fumigatus가 계속해서 분리 배양되었고 그리고 그들의 혈청에서 그러한 진균들의 항원에 대한 침강항체를 검충할 수 있었다. 3명의 환자는 폐기능이 진균종 제거수술을 허용하지 않았고 1명의 환자는 수술을 거부하였다. Four cases of pulmonary pseudallescheriasis in patients with healed pulmonary tuberculosis are described. All four patients had a long history of antituberculous chemotherapy for pulmonary tuberculosis, but continuous sputum negativity for acid fast bacilli indicated apparent recovery from tuberculosis. They, however, complained continued intermittent hemoptysis and chronic cough. Although their chest roentgenograms did not show a clearcut mycetomal shadows in preformed cavitary lung lesions, Pseudallescheria boydii or Scedosporium apiospermum was repeatedly isolated from serial sputum specimens collected at different days for a period of over half an year or two years and their serial serum specimens produced precipitin bands with home-made antigen from 8-week old culture filtrate of P. boydii. Second fungus was isolated from sputum specimens of two patients and one was Candida albicans and the other was Aspergillus fumigatus. Sera from both patients reacted with antigens of those second fungi. Unfortunately pulmonary function of three patients did not allow surgical excision of the infected area and one patient refused surgery.
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김상재,황해도,Kim, Sang-Jae,Hwang, Hae-Do The Korea Society for Microbiology 1986 大韓微生物學會誌 Vol.21 No.4
보관온도 및 기간에 따른 객담내 인형결핵균의 생활력 변화와 객담오염 방지를 위한 방부제의 선택을 위해 도말염색표본에서 현미경으로 항산균을 검출할 수 있었던 41개의 객담으로 관찰한 결과를 보면 다음과 같다. 객담을 $4^{\circ}C$에 보관할 경우 1주까지는 모두 배양검사에서 결핵균이 발육했으나, 2, 3, 4주에서는 각각 9.8%, 19.5% 및 25.8%의 객담이 배양에서 결핵균이 발육하지 않았다. $25^{\circ}C$에서는 1주에서도 19.5%의 객담이 배양음성이었고, 2, 3, 4주에서는 각각 36.6%, 70.7%, 90.2%가 배양음성이라 고온보관으로 균이 많이 사멸하는 것을 알 수 있었다. $25^{\circ}C$에서 객담을 1주이상 보관하면 오염율도 매우 높았다. 이와 같은 오염을 0.5% boric acid(BA), 5% trisodium phosphate(TP) 및 0.5% cetylpyridium chloride(CP) 첨가로 막을 수 있으나, CP를 제외하고는 결핵균에 유독해 방부제로 적합하지 않았다. CP 첨가 객담은 $25^{\circ}C$이상의 여름철 기온에서 3, 4주간 방치해도 각자 61.0% 및 31.7%가 배양에서 결핵균이 발육하였다. 그런데 BA첨가 객담은 같은 기간에 각각 34.1% 및 4.9%만이 배양양성이라 균에 유독함을 알 수 있었다. 따라서 여름철과 같이 기온이 높을 때 객담을 배양할 수 있는 검사실까지 운송하는데 2주이상 걸리는 상황에서는 CP가 유용한 방부제로 이용될 수 있다고 본다. The viability of tubercle bacilli in the sputum specimens has been investigated after different periods of storage at diffeent temperatures and in the presence of different preservatives. No loss of culture positives was observed for one week storage at $4^{\circ}C$, but 9.8% 19.5%C, and 26.8% of sputums failed to yield positives on 2, 3, and 4 weeks of storage respectively. At $25^{\circ}C$ even one week storage made 19.5% of sputums fail to yield positive culture and 2, 3, and 4 weeks of storage made 36.6% 70.7%, and 90.2% of sputums fail to yield positive culture respectively. And contamination was unacceptably high beyond one week of storage at $25^{\circ}C$. Contamination of sputum specimens could be protected fairly well by 0.5% boric acid, by 5% trisodium phosphate or by 0.5% cetylpyridium chloride, but, except CP, the former two had no advantage at all to protect viability of tubercle bacilli over the specimens without preservative. The CP was much less harmful to the viability of tubercle bacilli than BA, yielding 61.0% and 31.7% of culture positives on 3 and 4 weeks of storage in the presence of CP, while BA yielded 34.1% and 4.9% of positives on the same respective periods of storage. Therefore CP may be useful to preserve sputums if it takes more than 2 weeks to transport them at the temperature of over $25^{\circ}C$.
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