In recent years, it has been documented that tuberculosis frequently occurs among recently entered foreigners dominantly from Asia. We studied 85 cases admitted to our hospital for active tuberculosis from 1986 to 1990.
Many of those cases, we believe, were infected in countries of origin and were reactivated soon after or before entering Japan. In spite of higher rate of involving recurrent cases and resistance to anti-mycobacterial drug agents, chemotherapy has been generally efficient. In some cases, continuance of treatment was difficult because of their illegal stay, misunderstanding of the disease or other problems such as customs and economic difficulties.

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Therapeutic efficacy of kanamycin (KM) and clofazimine (CFZ) combined with N² [(N-acetyl-muramoyl)-L-alanyl-D-isoglutaminyl] -N⁶-stearoyl-L-lysine, MDP-Lys (L18), against Mycobacterium intracellulare infection induced in mice was studied, based on suppression of incidence of gross lung lesions and bacterial growth at the sites of infection (lungs and spleen), and the following results were obtained.
Firstly, KM (0.5mg) was given sc to mice, daily six times per week in combination (or not) with sc injections of MDP-Lys (18) (0.1mg) either 1, 3 or 5 times weekly. In this case, KM alone markedly suppressed the incidence of pulmonary gross lesions and the growth of organisms in the lungs and spleen (2-2.5 log-decrease in CFU per organ at week 8) in infected mice. MDP-Lys (18) alone also exhibited similar effect but the efficacy was much lower than that of KM. No synergism was observed for combined use of KM with MDP-Lys (18) in any protocols tested.
Secondly, CFZ (0.5mg) was given to mice by gavage, daily six times per week in combination with or without injections of MDP-Lys (18) (0.1mg), either 1, 3 or 5 times weekly. In this case, CFZ alone decreased the incidence of gross pulmonary lesions in infected mice and the weaker suppressive effect was noted for MDP-Lys (18) alone. Moreover, CFZ alone suppressed bacterial growth in the lungs and spleen (1.5-2.0log-decrease in CFU per organ at week 8), while MDP alone failed to cause such a marked reduction in bacterial CFU in the visceral organs. In this case, significant effect was not observed in combined use of CFZ with MDP-Lys (18) in all the test protocols, on the basis of change in CFU in the lungs.
The present study indicates that there was no appreciable combined effect against M.intracellulare infection, between either KM or CFZ and MDP-Lys (18), although KM and CFZ alone exhibited considerable therapeutic efficacy.

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The time of eradication of tuberculosis has been discussed for several countries, and based on those results, a new strategic plan and goals have been elaborated. Considering such developments, and in order to make a new tuberculosis control strategy, it is important to determine the point at which eradication of tuberculosis would be achieved in Japan.
Styblo proposed the two conventional definitions of eradication of tuberculosis, namely that the incidence of smear-positive tuberculosis has fallen below 1 per million population or that the prevalence of tuberculosis infection in the general population has fallen below 1% and continues to decrease.
The bacteriological results of new cases have been reported since 1975 in Japan. However, those results are still of doubtful validity and reliability. Therefore, the author estimated the year of eradication of tuberculosis, according to the criterion that tuberculosis is eradicated when the proportion of the population infected with tubercle bacilli is less than 1%.
If the risk of infection is changing at a regular rate, it is possible to estimate the risk of infection at any time in the past and in the future. Once the risk of infection is determined, it is also possible to calculate the age-specific prevalence of infection and the proportion of the population infected with tubercle bacilli at various times in the past and in the future.
In Japan, the risk of infection before World War II was assumed to be around 4% and not to vary with calendar year. And based on the data from the prevalence surveys in Okinawa in 1968 and 1973, the risk of infection was estimated 0.3% in 1968 and has declined on average, by 10 to 11% annually. At that time, Okinawa was the only area free from BCG vaccination in Japan.
The incidence rate in Japan also has declined, on average, by 10% annually. However, since late 1970s, the annual speed of decline of the incidence rate has been slowed down. Therefore, I assumed that the recent trend of the infection risk is the same as the trend of the recent incidence rate among the 0-29 year age-group.
The size of the effect of age on the risk of infection has been discussed. The author also considered age-effects in the model. The weight applied to the risk of infection by age was determined by examining the age-specific positive rate in the 1930s before the era when TICG vaccination was widely used.
Weighting the risk-difference by age to the model that the annual risk of infection up to 1947 was 4% constantly; since then, it declined by 10% annually up to 1977; since then, it has declined by 5% annually, I concluded that the eradication of tuberculosis in Japan will take place in 2058.

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Three-hundred and forty-four cases of active primary tuberculosis admitted to the National Sanatorium Seiransou Hospital from 1980 to 1987 were studied and compared with 101 cases admitted from 1966 to 1969. None had a previous history of tuberculosis, and all were diagnosed via positive smears for acid-fast bacilli and/or positive Mycobacterium tuberculosis cultures.
The age distribution showed that in the recent cases, the highest incidence among the male patients was observed in the middle-age group (30-59 yr) and in the older age group (over 60 yr) among the female patients. In the earlier cases, the younger (under 29 yr) and middle-age groups showed a higher incidence than the older age group for both sexes. However, when the prevalence rate was calculated for recent and past cases using the total population of the districts where the patients lived, it was observed that tuberculosis was most prevalent among the older age group for both sexes. Seventy percent of these cases were admitted to the hospital due to self-conscious symptoms, and 20% were referred as a result of mass-screening chest X-ray examinations. The rest of cases were discovered by routine radiographs taken during admission for unrelated illnesses.
Some of the middle-and older-aged patients had predisposing factors, such as diabetes mellitus, gastric ulcers and malignancy, in their past histories or as complicating diseases. Twenty percent of all cases had a family history of tuberculosis. In most cases, a second family member was admitted with tuberculosis within 10 years after the first family member's presentation however, some cases developed after 30-40 years. This fact suggests a possible hereditary or genetic disposition rather than direct transmission of M. tuberculosis.Drug resistance was observed in 5-19% of the primary cases, highest in the younger age group, in whom tuberculous lesions revealed on chest X-rays were unilateral rather than bilateral as in the older patients. Radiograph findings were primarily infiltrative in the past, whereas cavitation was the prominent feature in recent cases. Tuberculin skin testing was 90% positive in all groups except the older-age males, whose positivity rate was 71%. In the past, 25% of the cases were treated with both surgery and chemotherapy, including SM, PAS and INH, whereas only 2.5% were operated in recent cases. There were 11 cases (3.2%) of extrapulmonary tuberculosis that included involvement of the urinary tract, larynx, ribs and cervical lymph nodes.
Cessation of the expectoration of tuberculous bacilli was achieved more quickly in recent cases than past cases. The nine-month hospitalization observed in recent cases, was half that of past cases. Twelve patients (3.5%) died in the hospital. These were members of the older age group, and death was primarily due to malignancy complicated with tuberculosis.
The pathogenesis of tuberculosis in elderly people has been debated for many years. There is no reason to deny the possibility of exogenous reinfection. However, as the number of persons having contagious tuberculosis has been greatly reduced when compared to the past, one should not overlook the possible recrudescence of an infection acquired several decades ago, especially among older patients. Due to the high prevalence of tuberculosis among the middle-aged, the number of elderly with tuberculosis will rise in the future as today's patients age. Although its incidence is declining, one must remain aware and be cautious of the danger of tuberculosis.

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This report perta6ins to a case of chronic renal failure with remittent fever after tonsillectomy. The patient was 45-year-old female who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for five years. She was admitted to our hospital after being diagnosed as having pyrexia with tonsilitis. A tonsillectomy was performed.
Although several symptoms and signs, such as fever, positive CRP and accelerated ESR, improved transiently by the seventh postoperative day, remittent fever and cervical lymph node swelling suddenly recurred after the eigth postoperative day. In spite of the antibiotic therapy, the fever continued for two weeks thereafter.
A culture to check for acid-fast bacilli was negative, but on epithelioid cell granuloma with a small central abscess was found in the biopsy specimen of the lymph node. INH was prescribed to her. After three days of INH administration, the patient became afebrile. Patients with long-term dialysis are known to be very susceptible to tuberculous diseases. However, to date, there has been no report of tuberculosis being accompanied by a fever after a tonsillectomy. As it might be difficult to make a tubercular diagnosis on such a febrile patient, early antituberculous chemotherapy is recommended for patients with antibiotic-refractory fever.

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Recent trend of studies on the bacteriologic, pathogenic, epidemiologic and chemo therapeutic aspects of “atypical” mycobacteria, particulaly of Mycobacterium avium intracellulare complex, which is the most important causative agent of tuberculosis-like pulmonary disease in Japan were reviewed.

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