Kekkaku : [Tuberculosis]最新文献

[Objectives and Materials] Based on the tuber- culosis (TB) surveillance database, the incidence rates of TB infection and active disease among healthcare workers were observed for female nurses and male doctors in 2010 in comparison with those of the general population. [Results] The relative risk (RR) of active TB among female nurses aged 20-69 years was 4.86 (95% confidence interval: 4.31-5.45) for 2010, which has increased from 2.30 observed in 1987-1997. The RR was highest for nurses aged 20-29 years at 8.84 and declined with age until 3.60 for those aged 50-59 years that was still significantly higher than 1. For male doctors the RR was significantly higher than 1 only for those aged 39 years or younger. The rates of those who were -indicated for treatment of latent TB infection (LTBI) were clearly higher among healthcare workers; for female nurses the RR was 32.7 (95% CI: 30.5-35.0), ranging from the highest level of 62.8 among those aged 20-29 years down to 11.6 for those aged 60-69 years. For male doctors also, the RR was high at 9.7 (7.9- 11.7) for 20-69 years, ranging from 14.5 for those aged 20- 29 years down to 5.3 for those aged 60-69 years. [Discussion] TB cases of nurses and doctors were more likely to be detected by the active case finding measures such as periodic screening and contact investigations than cases in the general population, which indicates the current effort of addressing the occupational exposure in the healthcare set- tings. The high level of risk of TB disease as Iwell as LTBI among healthcare professions and its possibly increasing trend as. seen in female nurses warrants further strengthening of monitoring of the problem and overall countermeasures in their workplaces.

[Objective] To determine whether three sputum examinations with fluorescent staining are necessary to diag- nose tuberculosis (TB) in our hospital. [Patients] From April 2005 to December 2012, 379 TB patients were admitted and received anti-TB therapy in our hospital. [Methods] A retrospective study was conducted to assess the positivity rates of sputum smears based on three exami- nations. The positivity rate of first sputum smear and the cumulative smear-positive rates in the second and third were determined. Then, we also determined difference of positivity rates in sputum properties, sampling procedures and cavity formation. [Results] Of the 379 patients who met the screening criteria, 300 tested positive based on the first sputum smear (79.2%). The positivity rate of the first sputum smears was higher in the purulent sputum group than in the mucous sputum group (91.2% vs. 72.3%). Cavity formation, and sputum extraction procedures were not related to the positivity rate of the first sputum smears. In the mucous sputum group, the cumulative smear-positive rate in the second test significantly rose, but did not rise in the third test. [Conclusions] Three sputum smear examinations were necessary in patients who submitted mucous sputum samples. It is important to get purulent sputum.

Rifampicin can induce hypothyroidism. We report a case of pulmonary tuberculosis and tuberculous pleurisy that was complicated by rifampicin-induced hypothyroidism. The patient received rifampicin-based tuberculosis treatment and experienced persistent appetite loss, which led us to pro- vide concomitant hypothyroidism treatment. An 85-year-old woman with no underlying thyroid-related disease presented to her local hospital with a 3-month history of appetite and weight loss. A chest radiograph revealed pleural effusions and infiltrative shadows in the lower fields of both lungs, and we also detected high levels of lympho- cytes and adenosine deaminase levels (49.6 IU/1) in the pleu- ral effusion, with positive results from a polymerase chain reaction assay of a sputum sample. Thus, we diagnosed the patient with pulmonary tuberculosis and tuberculous pleurisy, and initiated treatment using isoniazid, rifampicin, etham- butol, and pyrazinamide. Her clinical course was good and her anorexia was improved. However, she subsequently experienced recurrent appetite loss, malaise, and bilateral lower-leg edema. Follow-up laboratory testing revealed that she had developed hypothyroidism. We started treatment using levothyroxine without interrupting the tuberculosis treatment. The loss of appetite and other thyroid-related symptoms were improved. The patient's thyroid function had been normal at her admission, and there were no findings of Hashimoto's thyroiditis or other thyroid conditions. Based on the clinical course, we conclude that the rifampicin induced the hypothyroidism. Therefore, rifampicin-induced hypothyroidism should be considered in cases with persistent appetite loss, even if the patient appears to be experiencing anorexia as an adverse drug reaction.

[Aim] To explore the possible role of social network analysis (SNA) in identifying infected contacts and visualizing data in a tuberculosis (TB) contact investigation. [Method] We analyzed TB contact investigation data from an outbreak in a Japanese language school in Tokyo, Japan, in 20XX. Information on places which the index case and his contacts commonly shared was collected in line with the data collected routinely in contact investigation. Average hours of exposure to the index case were calculated for each contact by using SNA software, and the relationship to the index case via commonly shared places was visualized as a sociogram. Statistical analysis was performed to. compare the exposure hours and TB infection statuses, between those . infected, including active TB and latent TB infection (LTBI), and non- infected contacts. [Result] The data on the index TB case and 41 contacts, of whom 5 and 10 were diagnosed with active TB and LTBI, were analyzed. Contacts with active TB and LTBI had 12.5 and 11.5 times longer median hours of exposure, which were significantly longer compared to non-infected contacts. The sociogram summarized the network of index TB case, contacts characterized by exposure hours and infection statuses, and the places shared by the index case and the contacts. [Discussion] SNA analysis was considered to be useful in prioritizing contacts in a TB contact investigation, in assisting interpretation of indeterminate Interferon-Gamma release assay test results, in estimating places where transmission occurred, and visualizing data accrued in TB contact inves- tigations.

[Objective] We experienced use of new anti- tuberculous drug, Delamanid in multi- and extensively drug resistant tuberculosis (M (X) DR-TB) in our hospital. [Materials and Methods] Fifteen cases who were diagnosed M(X)DR-TB had been used Delamanid in our hospital from 2014 to 2015. [Results] The gender distribution consisted of eleven males and four females in M(X)DR-TB. The mean age was 53.3 years old in male and 28.3 years old in female. Japanese were eight cases, and Chinese were five cases, and other countries patients were two cases. Twelve cases were MDR-TB cases, and three cases were XDR-TB cases. Six cases of fifteen cases were sputum culture positive before using Delamanid. Two cases (13.3%) had been appearanced QTc extension in EKG by using Delamanid. But these cases had not seen symptom. Other typical side effects had not seen. Six cases (40.0%) of fifteen cases had done surgical resection. One case of fifteen cases had been died with intractable pneumothorax, and one case had been discontinued for leukopenia. All cases containing two discontinued cases had obtained negative conversion of sputum culture. [Conclusion] We experienced new anti-tuberculous drug, Delamanid. If we add Delamanid only for MDR-TB patients with only one or two sensitive anti-tuberculous drugs, it will be possible to make anew resistance. We used one more another new drug, for example Linezolid or high dose isoniazid or Meropenem and Ampicilin Clavulanate acid with Delamanid and sensitive anti-tuberculous drugs. We need to investigate risk and benefit when we use new anti-tuberculous drug. We need not to make more another MDR-TB cases.

The prevalence of nontuberculous mycobacterial (NTM) pulmonary disease is increasing in Japan and worldwide, and the importance of proper diagnosis and management of the disease has been recently recognized. Mycobacterium aviun complex (MAC) is the most common and important causative agent of pulmonary disease among nontuberculous mycobacteria. I have described the latest epidemiology of NTM lung disease, clinical feature, disease type, disease progression, diagnosis including serodiagnosis, and treatment strategy of MAC lung disease in this report. There are a lot of unsolved problems in the field of NTM lung disease, therefore, further investigations are required.

In recent years, administration- of biologics for immunologic inflammatory diseases, particularly rheumatoid arthritis, has increased obviously. These substances have dramatic effects, but complications of various infections such as tuberculosis are increasing. Biologics is an antonym for synthetic products (compounds), which are the most common type of pharmaceuticals, made by bioengineering materials derived from living organisms including humans. As concerns preparations which inhibit TNF-α that constitutes the basis of human immunity to tuberculosis, there was a fear that there might be an increase in tuberculosis in Japan, where many people have a history of tuberculosis infection due to past epidemics. However, it was confirmed in post-marketing all- case surveillance in Japan that tuberculosis dan be prevented by screening for latent tuberculosis infection (LTBI) in the target patient population, and administering an anti-tubercu- losis drug to patients with the finding of infection before administering a TNF-α inhibitor. The efficacy of prophylaxis is not 100%, however, so there were some patients who not only had complications of tuberculosis, but in whom symp- toms rapidly exacerbated and resulted in death. Since there is a high possibility that death was due to an immune reconstitu- tion inflammatory syndrome, it is necessary to consider re-administering biologics, or administer them continuously without'interruption. As concerns non-tuberculous mycobac- teriosis (NTM) which is rapidly increasing in Japan, on the other hand; its clinical manifestation is non-uniform and lacks effective therapeutic drugs, so administration of biologics had been considered to be contraindicated, but from a close analysis of clinical cases, there is a growing recognition that biologics can be administered under certain conditions.

Controlling tuberculosis (TB) among foreign- born persons is an important issue in Japan. The number of foreign-born patients with TB has been slightly increasing yearly, whereas that of Japan-born patients with TB has been decreasing. Some foreign-born 'persons visited Japan with active TB due to the lack of useful medical checks performed before immigration. The percentage of those with TB among foreign-born persons is high (up to 43%) in the younger generation, especially those in their 20s. Currently, multidrug- resistant TB occurs at a low frequency in Japan; however, there is a danger of persons being easily immigrated into Japan from high-burden countries. Physicians need to be aware that TB is an imported infection. Additionally, a strategy for controlling TB in foreign-born persons (e.g., performing medical checkups before immigration, conducting target medical checkups of high-risk people for TB, administering chemoprophylaxis to foreigners, reconsidering the public medical insurance system for TB treatment, and offering patient support) needs discussed.

[Objective] The infectious disease control law has been amended in May 2015, and the category definition of Mycobacterium tuberculosis as infectious pathogen has been changed, following the definition of extensively drug-resistant M.tuberculosis (XDR-TB) by World Health Organization. To assess the diagnostic capacity of XDR-TB, we conducted an external quality assessment (EQA) for the anti-tuberculosis drug susceptibility testing (DST). [Method] A total of 10 M.tuberculosis strains with known drug susceptibility were sent to each participating laboratory. The drugs assessed were isoniazid (INH), rifampicin (RFP), streptomycin (SM), ethambutol (EB), levofloxacin (LVFX), and kanamycin (KM). DST was performed using each routine method(s), and the results were compared with the judicial diagnoses. The sensitivity, specificity, overall agreement (effi- ciency) and kappa coefficient were calculated for each drug tested. In addition, the diagnostic accuracy of multidrug-resis- tant M. tuberculosis (MDR-TB) and XDR-TB was assessed. [Results] A total of 88 institutes including 67 hospitals, 16 commercial laboratories, and 5 public health laboratories par- ticipated in the EQA. With 2 laboratories submitting 2 sets of results, a total of 90 independent data sets were analyzed. As for INH, RFP and LVFX, the efficiency was over 95%, but we found two strains each for SM, EB and KM with the efficiency less than 95%. Especially, strain 1 and strain 2 showed efficiency of 72.2% and 71.1% to SM, respectively. This error was mainly found in a certain test kit. If we consider the passing score as showing ≥95 % sensitivity and specificity both to INH and RFP, the diagnostic accuracy of MDR-TB was 92.2% (83/90) in this study. With the same criteria to INH, RFP, LVFX and KM, that of XDR-TB was 79.7% (63/79). [Discussion] The diagnostic capacity of XDR-TB was not sufficient in the current study. Good case management and pathogen control requires higher accuracy. The government may need to conduct a constant EQA and relevant remedial actions.

[Objective] A delay in the diagnosis of tubercu- lous spondylitis can result in worsening of the condition. We investigated previously reported cases of tuberculous spondylitis, as well as cases experienced in our hospital, to identify factors that are useful in the diagnosis. [Materials and Methods] We retrospectively evaluated six cases of tuberculous spondylitis diagnosed in our hospital between October 2007 and September 2012, and an additional 23 cases that had been reported in Japan between 1994 and 2014. [Results] The median age of our six patients was 78.5 years and five were women. In all cases, the focal lesion was seen in 2-3 adjacent vertebrae; four patients had miliary tuberculosis and five had lower back pain. All patients received oral treatment for 10-12 months. Among the 23 patients previously reported, 57% were women, and a focal lesion was found in 2-3 adjacent vertebrae in 86%. In addition, 57% had miliary tuberculosis and 65% had lower back pain. A personal and family history of tuberculosis was found in 20% and 26%. [Discussion] Radiographic assessment and microbiological testing of areas other than the chest and spine are useful in the diagnosis of tuberculous spondylitis. Furthermore, lower back pain, lower extremity symptoms, and personal and family history of tuberculosis are important factors. [Conclusion] When tuberculous spondylitis is suspected, diagnosis may be possible by investigating focal lesions in areas other than the spine.