Shinji Shishido

Comparative antimicrobial activities of the newly synthesized quinolone WQ-3034, levofloxacin, sparfloxacin, and ciprofloxacin against Mycobacterium tuberculosis and Mycobacterium avium complex.

ABSTRACT WQ-3034 is a newly synthesized acidic fluoroquinolone. We assessed its in vitro activity against Mycobacterium tuberculosisand M. avium complex using levofloxacin (LVFX), ciprofloxacin (CPFX), sparfloxacin (SPFX), and KRM-1648 (KRM) as reference drugs. The MICs of these agents were determined by the agar dilution method with 7H11 medium. The MICs at which 50 and 90% of the test strains were inhibited (MIC50s, and MIC90s, respectively) for the test quinolones for rifampin (RMP)-susceptible M. tuberculosis strains were in the order SPFX < LVFX ≦ WQ-3034 ≦ CPFX, while those for RMP-resistant M. tuberculosis strains were in the order SPFX ≦ WQ-3034 ≦ LVFX < CPFX. The MICs of KRM for RMP-susceptible M. tuberculosis were much lower than those of the test quinolones, while the MIC90 of KRM for RMP-resistant M. tuberculosis strains was higher than those of the quinolones. The MIC50s and MIC90s of the test drugs for M. avium were in the order KRM < SPFX < CPFX ≦ WQ-3034 ≦ LVFX, while those forM. intracellulare were in the order KRM < SPFX < WQ-3034 ≒ LVFX ≦ CPFX. Next, we compared the antimicrobial activities of the test drugs against M. tuberculosisorganisms residing in cells of the Mono Mac 6 macrophage (Mφ)-like cell line (MM6-Mφs) and of the A-549 type II alveolar cell line (A-549 cells). When drugs were added at the concentration that achieves the maximum concentration in blood, progressive killing or inhibition of the M. tuberculosis organisms residing in MM6-Mφs and A-549 cells was observed in the order KRM > SPFX ≧ LVFX > WQ-3034 > CPFX. The efficacies of all quinolones against intracellular M. tuberculosis organisms were significantly lower in A-549 cells than in MM6-Mφs. WQ-3034 at the MIC caused more marked growth inhibition of intramacrophage M. tuberculosis than did LVFX. These findings indicate that the in vitro anti-M. tuberculosis activity of WQ-3034 is greater than that of CPFX and is comparable to that of LVFX.

A SURVEY ON THE ONSET OF TUBERCULOSIS IN NURSING HOMES

PURPOSEnTo obtain the informations how to promote early detection and prevention of nosocomial infection of tuberculosis in nursing homes for the elderly.nnnSUBJECTnFifteen elderly patients who developed tuberculosis from 1998 to 2002 at nursing homes within a certain health center jurisdiction area which has a total of 23 nursing homes were investigated.nnnMETHODnWe collected informations on these 15 patients concerning the clinical conditions, details of contact examinations and status of chemoprophylaxis by using TB registration card in the health center and interviewing with the members of staff of the nursing homes and hospitals, and case conferences conducted at the health center.nnnRESULTSnFour patients died within 10 days after the diagnosis due to the delay in referring them to doctors. The most common symptoms leading to the detection was fever, followed by cough.nnnDISCUSSIONnEarly diagnosis is the key to prevent early death and nosocomial infection of tuberculosis in nursing homes. A similar study will be useful at each health center or region to improve the tuberculosis control in nursing homes.nnnCONCLUSIONnTuberculosis control programs in nursing homes should be strengthened. The staff of nursing homes should be trained for closer observations of the elderly about their health conditions such as fever and cough, and their early reference to physicians when such symptoms were observed. Two step tuberculin skin tests to the staff is also important for the contact investigations.

Clinical evaluation of patients with pulmonary tuberculosis during the past 10 years in our hospital

The background of patients who died of active pulmonary tuberculosis during 10 years period (1989 to 1998). Of 973 tuberculosis patients, 76 patients died, of which 56 died of non-tuberculosis, and 20 died of tuberculosis. A total of 12 patients died within 3 months after being hospitalized. The period from hospitalization to death was significantly shorter in tuberculosis patients with independent gait failure, original treatment, without tuberculosis medical history, and no drug resistance. We considered that in tuberculosis death, severe tuberculosis itself is the cause of early death, and recurrence and drug resistance patients are the most serious problems in later deaths.