As the situation of tuberculosis is strongly influenced by environmental and socioeconomical conditions of patients, as well as by epidemiological status of the area, the incidence and prevalence rates differ markedly area by area even in a developed country like Japan.
The incidence of pulmonary tuberculosis and its trend were studied in the area around Shimada city (population about 110, 000) during the period of 1981-82. The result of treatment of 1, 054 patients with pulmonary tuberculosis treated at our hospital between 1979-83 were analyzed, and the regimens of chemotherapy were indicated in Table 1.
The incidence rate of tuberculosis in this area was 115 per 100, 000 in 1981 and fell down to 68 in 1982, and the rates were higher than the rates of whole Japan which were 56 and 54, respectively. The prevalence of tuberculosis in this area was 434 and 314, respectively in 1981 and 1982, while the rates were 350 and 336 in the whole country.
The average duration of treatment of 1, 504 patients was 3.17 years, and it was longer than the prefectural average (2.8 years) and the national average (3.1 years).
The rate of relapse of our cases was 3.3%. About 80% of the relapsed cases were complicated with diabetes, cardiac diseases, gastrointestinal disorders or alcholism.
Twenty-five patients with localized lesions were treated with surgical procedures, which included 3 pleuro-pneumonectomies, 15 lobectomies, 3 segmentectomies, 1 partial resection, 2 rib resections for involvement of thoracic wall lesion, and one diagnostic mediastinal lymph node resection.
In conclusion, the short-course chemotherapy seems to be contraindicated for severely complicated patients, and sufficient treatment course with a longer follow-up period (preferably 7 years) is needed for such cases.
