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한국산 다람쥐 (Eutamias sibiricus asiaticus)를 이용한 피부결핵증의 항산균 검출에 관한 연구

Title
한국산 다람쥐 (Eutamias sibiricus asiaticus)를 이용한 피부결핵증의 항산균 검출에 관한 연구
Other Titles
A study of mycobacteria from lesions of skin tuberculosis through inoculation of the Korean chipmunk(Eutamias sibiricus asiaticus)
Authors
최정희
Issue Date
1978
Department/Major
대학원 의학과
Publisher
이화여자대학교 대학원
Degree
Master
Advisors
유준
Abstract
The identification of tubercle bacilli from skin lesions is required to make a definite diagnosis of skin tuberculosis. However, not only are clinical lesions quite variable, but also the amount of acid fast organisms contained in such lesions is so small that the identification of tubercle bacilli from these lesions has been found a matter of difficulty (Nguyen 1973; Yamauchi, Klein, and Farrell 1973, Smith, Ryan, Sanderson and Sarkany 1976). In the present study, the isolation and identification of acid fast organisms from suspected skin tuberculosis cases was attempted by employing the Korean chipmunk (Eutamias sibiricus asiaticus) as an experimental animal, as these animals have been reported to be susceptible to various acid fast organisms, including tubercle bacilli (Chang, Lew and Choi 1971; Choi, Lew Kim, Kim and Pyun 1972; Kang and Lew 1976). The following is a summary of the findings in this study. 1. There were no acid fast organisms detected in any of the materials which were prepared by direct and concentration smears of the lesions of 17 suspects. Two strains of acid fast organisms were isolated from the lesions of skin tuberculosis after culturing them for one week in vitro. By the chipmunk inoculation method, two strains were isolated from the lesions at the 3rd and 4th weeks after inoculation. 2. In physicochemical analysis of the above 4 strains, 2 from in vitro culture and 2 from chipmunk inoculation, the 2 strains from the chipmunk inoculation were identified as Mycobacterium tuberculosis and the 2 strains from in vitro culture were identified as rapid growers, both of them being atypical acid fast organisms. The two strains of Mycobacterium tuberculosis were isolated from 2 patients who were preliminarily diagnosed as having Lupus vulgaris. Mycobacterium fortuitum was isolated from a case of Erythema induratum and the other unidentified atypical mycobacterium from a patient with Lupus erythematosus. 3. The susceptibility of the 4 isolated strains of mycobacteria to the primary antituberculosis drugs was also tested in vitro. The two strains of Mycobacterium tuberculosis were found to be susceptible to 10-100 ug/ml of PAS and SM. The Mycobacterium fortuitum showed resistance to all of the drugs tested. The unidentified rapid grower demonstrated susceptibility to PAS and SM at a concentration of 100 ug/ml. As a final summary, a total of 4 strains of acid fast organisms, 2 from cultures and 2 from chipmunk inoculation, were successfully isolated. Therefore, the Korean chipmunk is recommended as an experimental animal for the identification of acid fast organisms obtained from suspected skin tuberculosis patients. However, the 2 strains of atypical acid fast organisms isolated from the culture were not detected in the inoculated chipmunks. Thus, it is still necessary to study further the question of whether or not chipmunk inoculation alone can provide a satisfactory method for the identification of atypical mycobacteria from skin tuberculosis.;피부결핵의 확진에는 피부병소에서의 항산균 검출이 절대적으로 필요한 방법이 되나 그 병소가 다양하고 항산균의 수가 적어 피부결핵의 진단이 용이하지 않다고 보고 되고 있다. (Nguyen 1973 ; Yamauch ,Klein, and Farrel 1973 ; Smith, Ryan, Sanderson and Sarkany 1976) 이에 저자는 결핵균 뿐아니라 각종 항산균에 대한 감수성이 높다고 보고된 (장 훈영 , 유 준, 최 대경 1971 ; 최 대경, 유 준, 김 주덕, 김 성광, 변 우섭 1972 ) 한국산 다람쥐를 이용하여 피부결핵으로 의심되는 환자를 대상으로 하여 이들 피부병소에서 항산균의 검출을 시도 하였다 . 1 . 피부결핵으로 의심되는 환자 총 17 예의 생검조직에서 직접 및 집균 도말후 현미경 경검하에서 항산균 검출은 전혀 관찰되지 않았고 배양기내 배양법에서는 1 주만에 2 주가 분리되었다. 그러나 한국산다람쥐의 접종에 의한 항산균 검출성적에서 접종후 3 주 및 4 주에 각각 1 예씩 2 주의 항산균이 검출되었다. 2 . 배양기내 에서 배양분리된 균주2주 및 접종된 동물에서 분리된 균주 2 주 총4 주를 물리적 및 생화학적 실험에 의해 동정한 결과 배양기내 배양에 의해 분리된 2주는 비정형항산균으로서 이 중 1주는 M.fortuitum으로 또 다른 1주는 미분류 발육신속균으로 각각 동정 되었다. 다람쥐 접종으로 분리된 인형결핵균은 임상적으로 심상성낭창( Lupus vulgars )으로 예진된 2예에서 분리되었으며 배양법으로 분리된M. Fortuitum은 경결성 홍반(Erythema induratum)으로 예진된 1예에서 , 미분류 비정형항산균은 홍반성 낭창(Lupus erythematosus)으로 예진된 1예에서 각각 분리되었다. 3. 분리검출된 항산균 4주에 대한 시험관내 약제내성검사 결과 인형 결핵균으로 동정된 2주중 1주는 PAS 및 SM에 대하여 100㎍/ml농도에서 감수성을 보였으며 다른 1주는 INH, PAS 및 SM 에 대하여 10㎍/ml이상의 농도에서 감수성을 보였다. 한편 M. fortuitum으로 동정된 1 주는 모든 약제에 대해 내성을 보였으며 미분류발육신속균주로 동정된 1 주는 PAS 와 SM에 대하여 100㎍/ml의 농도에서 감수성을 보였다 .
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