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Volume 73, Issue 6
Displaying 1-5 of 5 articles from this issue
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Katsumi YAMANAKA, Tomi AKASHI, Masaru MIYAO, Shin'ya ISHIHARA1998 Volume 73 Issue 6 Pages 387-394
Published: June 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA survey was conducted to clarify the tuberculosis (TB) situation among the homeless during the period from 1991 to 1995 in Nagoya city, using 5, 222 registration cards of TB cases registered at one of Nagoya City's 16 Health Centers. Out of 5, 222 TB cases, there were 269 homeless cases (267 male and 2 female). Ninety-seven percent of them were pulmonary TB cases. The incidence and prevalence rates of TB per 100, 000 among the homeless were estimated at around 1, 500 and around 2, 400, respectively, around 20 times higher than those of the non-homeless male over the 19 years of age. A decrease in the incidence rate of TB cases among the homeless was not seen, although the rate among the non-homeless decreased gradually. The percentage of infectious (bacillary and/or cavitary) tuberculous cases among the homeless was higher than in the non-homeless. In the infectious cases, the percentage of smear-positive bacillary cases or far advanced cavitary cases was 52.1% or 9.4% among the homeless compared to 48.1% or 2.6% among the non-homeless, respectively. The detection rate by chest X-ray examination of the homeless was 3.9%.View full abstractDownload PDF (898K) -
Hidetoshi IGARI, Ikushi ONOZAKI, Yuko SUNAMI, Kiminori SUZUKI, Akimits ...1998 Volume 73 Issue 6 Pages 395-401
Published: June 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSIn Japan, BCG vaccination, which covers more than 90% of infants, has been given according to the national immunization policy. Moreover, first-grade children in elementary school are screened with tuberculin skin test, and those who show negative reaction in the Japanese standard, i.e. size of erythema less than 10mm, are re-vaccinated with BCG according to the Tuberculosis Prevention Law. However, since the incidence of tuberculosis among children below age 14 is as low as 1.5/100, 000 in Japan, it is time to reconsider the BCG vaccination policy.
As the first step to assess the efficiency of the present program, we observed the occurrence of Koch's phenomenon after BCG vaccination in elementary school children in Chiba City in 1995 and 1996, and we introduced the two-step tuberculin test to elementary school children in 1997.
Among 180 BCG vaccinated children in 1995 and 1996, 168 (93.3%) had been vaccinated by 4-year of age. We could follow local reaction of BCG re-vaccination and observed Koch's phenomenon in 117 (69.6%, 95% C.I. of 62.7-76.6%).
Among 92 tuberculin negative children in 1997, 85 (92.4%) had been vaccinated by 4-year of age. In the two-step tuberculin test program of 85 initial negative-reactors, 63 (74.1%, 95% C.I. of 64.8-83.4%) turned to positive by the second test.
Those results suggest that more than 69% of tuberculin-negative school chidren who were vaccinated previously maintained immunity with BCG. Our studies raised a problem of the current BCG re-vaccination policy that depends on the result of tuberculin test. Due to the discrepancy between tuberculin allergy and immunity in tuberculosis, many school children may be given BCG vaccination unnecessarily. Taking into consideration the incidence of tuberculosis in children, discontinuation of BCG re-vaccination policy atelementary school entrance should be considered.View full abstractDownload PDF (1023K) -
Hideaki ISHIBATAKE, Reiko ONIZUKA1998 Volume 73 Issue 6 Pages 403-411
Published: June 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 52-year-old woman visited a physician on Oct. 17, 1995 because of dizziness, general fatigue and a slight fever. A Chest X-ray film showed micronodulous and infiltrative shadows in the bilateral upper lung fields. Liver dysfunction was also recognized. As dyspnea and hypoxemia progressed very rapidly, the patient was intubated and kept under mechanical ventilation. A diagnosis of miliary tuberculosis with adult respiratory distress syndrome (ARDS) was made based on the detection of acid-fast bacilli from sputum obtained from the endotracheal tube. She was admitted to our hospital on Oct. 24, 1995 receiving anti-tuberculous drugs combined with high-dose methylprednisolone. As disseminated intravascular coagulation (DIC) and acute pancreatitis also developed, gabexate mesilate was added to the preceding therapy. This combination therapy was effective and the patient gradually improved.
Two months after the admission, aneurysms of the abdominal aorta and left renal artery were discovered. As the size of the aneurysms had been increasing along with abdominal and low back pain, the patient was transferred to an other hospital for surgical treatment. She underwent a successful operation for pseudoaneurysms, the etiology of which was tuberculosis according to pathological findings and detection of acid-fast bacilli from the resected specimens. This is the 10th case of tuberculous aneurysm of the aorta which was successfully operated on in Japan.
ARDS, DIC and aneurysm occure rarely as complications of miliary tuberculosis, but they are life-threatening, and lead to a serious prognosis if untreated. Early diagnosis of miliary tuberculosis and tuberculous aneurysm is very important for a good outcome.View full abstractDownload PDF (12617K) -
1998 Volume 73 Issue 6 Pages 413
Published: 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (1131K) -
[in Japanese]1998 Volume 73 Issue 6 Pages 447-458
Published: June 15, 1998
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (1309K)
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