非定型抗酸菌ツベルクリンの臨床応用 : <I>Mycobacterium intracellulare</I>より作成したPPD-Bと<I>M. tuberculosis</I>青山B株よりのPPDsの皮内反応比較による鑑別診断
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To reveal the possibility of differentiating diseases caused by M. tuberculosis and <I>M. intracellulare</I>, simultaneous tuberculin testing by PPDs and PPD-B was carried outamong X-ray suspects of tuberculosis and healthy persons.<BR>PPD-B was prepared by Dr. Tasaka (Department of Bacteriology, Hiroshima University) from <I>M. intracellulare</I> (ATCC13950).<BR>For tuberculin testing, 0.05μg of PPDs from <I>M. tuberculosis</I> (Nihon BCGCo.) and 0.1, μg of PPD-B were used.<BR>The study included61patients with disease caused by <I>M. tuberculosis</I> (TB), 23 patients with that of <I>M. avium complex</I> (MAC) and 40 healthy persons with no roentgenologicalabnormality (H).<BR>Forty healthy persons had been vaccinated with BCG. Statisticalanalysis of the diameter of reaction (redness) in each antigen in each group has been doneby Boxplotting method.<BR>The results were as follows: 75% upper quartile point, median, 25%lower quartile point/mean S. D.: PPDs in TB (41.8, 30.0, 19.0/32.0-17.7) PPDB in TB (15.0, 10.5, 5.0/10.9 8.1) PPDs in MAC (26.0, 10.0, 7.0/16.4-13.9) PPDB in MAC (20.5, 17.5, 12.5/19.1-11.4) PPDs in H (18.0, 12.0, 6.0/13.5-10.9) PPDB in H (7.0, 2.8, 0.0/4.4-5.4).<BR>Mean of PPDs in TB patients and PPD-B in MAC patients were significantly (P<0.01) larger than those in other groups. Significant differences of reaction by age distribution, previous history of mycobacteriosis or other diseaseswere not observed.<BR>In each patient, larger skin test reaction correlated with the infected organism in 71 (85%) of the 84 cases.<BR>In 61 patients with <I>M. tuberculosis</I> infection, reaction to PPDs waslarger than that of PPD-B in 58, and the reaction to PPD-B was larger than that of PPDs in only one subject, and the reaction to PPDs and PPD-B were smaller than 5mm in 2. In 23 patients with MAC infection, the reaction to PPD-B was larger than that of PPDs in 13, the reaction to PPDs was larger than that of PPD-B in8and the reaction to PPDs and PPD-B were smaller than 5mm in 2.<BR>It is concluded that simultaneous skin test with PPDs and PPD-B is useful in thedifferential diagnosis of mycobacterial disease due to M. tuberculosis and <I>M. aviumcomplex</I> prior to bacteriologic confirmation by culture.
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