結核性髄膜炎は治療マネジメントに難渋し，かつ予後も悪い疾患である．一方で，近年結核患者の減少に伴い，結核性髄膜炎を経験する機会も減少しているため，その特徴や臨床経過への理解は重要である．本研究では，2012年4月から2022年3月までの間に公立陶生病院に入院し，結核性髄膜炎の診断を得た18歳以上の患者を対象とし，その臨床的特徴や経過と予後について検討した．症例は14例（男性8例，女性6例），平均年齢は70.5歳（±18.0歳），日本人は13例，2例に過去の結核既往を認めた．肺結核は12例，尿路結核は8例，粟粒結核は12例に認められた．入院時の症状は，頭痛を6例，意識障害を6例，発熱を6例，脳神経麻痺症状を3例，痙攣，体重減少，呼吸困難をそれぞれ1例に認めた．頭部MRIでは脳梗塞が5例，結核腫が5例，水頭症が1例に認められた．髄液から菌体の確定を得たのは3例であった．抗結核薬は全例に使用され，ステロイドは12例に併用された．入院期間の中央値は71.5日間（範囲：36.8～110.5日間）であり，退院時死亡は4例，退院時後遺症を残した例は8例であった．結核性髄膜炎は髄液からの菌体の検出が難しいため症状や画像および経過から疑う必要があり，全身状態の低下した高齢者が中心であったことからも死亡例や後遺症を残して退院する例が多かった．結核性髄膜炎は，報告は少ないものの適切な治療マネジメントを要する疾患であり，今後の症例の蓄積と病態への理解が重要である．

Objective: This study aimed to describe the impact of Clostridiodides difficile infection (CDI) on health-related quality of life (HRQoL) among hospitalized adults in Japan.

Methods: HRQoL data were collected as part of an active surveillance study conducted in nine hospitals in Ota-ku (Tokyo), Japan. Among adults aged ≥50 years with onset of ≥3 unformed stools within 24 hours and Bristol score ≥5, stool samples were collected and tested for C. difficile. EuroQOl 5-dimensions 5-levels (EQ-5D-5L) index and EQ-5D-5L visual analogue scale (EQ-VAS) data were collected at baseline and at 90-day follow-up. Descriptive statistics and paired t-tests were performed to examine change in HRQoL; EQ-5D-5L index and EQ-VAS scores of cases (CDI+) were informally compared with published Japanese population norms.

Results: Of 1,384 patients enrolled in the study, 21 (CDI+) and 39 (CDI-) completed the EQ-5D-5L measures. The EQ-5D-5L index scores for both CDI+and CDI- groups increased over time (0.63±0.30 to 0.83±0.17 and 0.60±0.30 to 0.74±0.21, respectively). Despite the observed improvement from baseline, CDI+patients possessed poorer HRQoL at both timepoints than the general Japanese population, including among adults aged 65-74 years (0.76-0.85 vs. 0.91) and among those aged ≥75 years (0.59-0.78 vs. 0.87), respectively. A similar pattern of results was also found for EQ-VAS scores.

Conclusions: Even in milder cases, CDI may be associated with impairment in HRQoL. Although a trend of improvement in HRQoL was observed, results suggest that impairment may nonetheless persist for months after CDI. These findings highlight the unmet need for public health interventions that can reduce CDI burden in Japan.