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Volume 80, Issue 7
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Kunihiko ITO2005 Volume 80 Issue 7 Pages 521-526
Published: 2005
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Purpose] To investigate the usefulness of chest X-ray investigation for early diagnosis of recurrent pulmonary tuberculosis.
[Object] Patients who start re-treatment at Fukujuji Hospital from 1993 to 2003 due to the recurrence of lung tuberculosis after the completion of standard chemotherapy.
[Method] Chart review.
[Result] Deterio ration of chest X-ray was not observed in 19.5% (8/41) of recurrent pulmonary tuberculosis, and in 4cases even improvement of chest X-ray finding was observed. Sensitivity of chest X-ray in all recurrent cases was around 80%, and this figure did not increase in smear positive recurre nt cases. 'Sensitivity of chest X-ray for symptomatic recurrent cases was 92.3%, and that for non-symptomatic recurrent cases 60.0%, which is significantly lower than that for symptomatic cases.
[Conc lusion] Sensitivity of chest X-ray for early diagnosis of recurrent pulmonary tuberculosis is not very high, and bacteriological examinations are more important irrespective of chest X-ray finding. Especially in non-symptomatic recurrent cases, usefulness of chest X-ray is considerably limited. Method and necessity of regular follow-up in non-symptomatic persons after successful tuberculosis chemotherapy should be re-considered.View full abstractDownload PDF (3662K) -
Kazushi FUNAYAMA, Aiko TSUJIMOTO, Masaaki MORI, Hiromi YAMAMOTO, Keiko ...2005 Volume 80 Issue 7 Pages 527-534
Published: 2005
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS[Purpose] This study examined the usefulness of QuantiFERON®TB-2G (QFT) i. e., a novel technique for detecting tuberculosis infection based on the whole blood interferon-gamma response to specific antigens, in the investigation of a tuberculosis outbreak among university students.
[Subjects and Method] One university student was diagnosed as smear-positive pulmonary tuberculosis. In order to determine the extent of tuberculosis infection among contact students, tuberculin skin tests and QFT were performed on the close-contact group (220 people), as well as on the non-closecontact group (242 people).
[Results] Nine st udents were found to be TB either clinically or on the X-ray screening in the contact investigation. In the close-contact group, the QFT-positive rate was 32.7%. The proportion of those exhibiting tuberculin reactions with erythema diameters of 30 mm or larger was 57.7%. In the non-close-contact group, the QFT-positive rate was only 0.8%, as expected from the current healthy Japanese youths of this age. In contrast, strong tuberculin reactions with erythema of 30 mm or larger were seen in 18.2% in the latter group, most likely due to the previous history of BCG vaccination.
[Conclusion] QFT was clearly demonstrated to be a useful method for diagnosing tuberculosis infection, especially among subjects who show tuberculin reactivity due to past BCG vaccination. At the same time, the current criteria for the indication of chemoprophylaxis based on the strong tuberculin reaction were considered to be unreliable, causing many subjects with strong reactions to be given unnecessary preventive medications.View full abstractDownload PDF (1448K) -
A CASE OF ESOPHAGEAL TUBERCULOSIS WHICH DEVELOPED DURING THE TREATMENT FOR TUBERCULOUS LYMPHADENITISTomohiro HASHIMOTO, Yuka SASAKI, Takenori YAGI, Meishi ITAKURA, Rei SU ...2005 Volume 80 Issue 7 Pages 535-539
Published: 2005
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 23-year-old man was admitted to the other hospital complaining of fever and lymph node swelling in the left neck. Computed tomography showed swollen mediastinal lymph nodes without intrapulmonary lesions. Mycobacterium tuberculosis were identified by sputum culture and cervical lymph node biopsy and the case was diagnosed as tuberculous lymphadenitis. Three weeks after starting treatment with four anti-tuberculous drugs, he complained chest pain while eating and chest X-ray showed a new infiltrative shadow in the right cardiophrenic angle, then he was admitted to our hospital. Esophagoscopy revealed a deep ulceration with fistulas at 30cm from the incisor and he was diagnosed as esophageal tuberculosis by histological examination of the biopsy specimen showing remarkable leukocytes infiltration and epithelioid cell granulomas with a few multinucleated giant cells. After antituberculous chemotherapy for six months, the mediastinal and cervical lymphadenopathy were reduced in size and the esophageal ulceration almost disappeared. Although esophageal tuberculosis is rare, the disease might develop during or after mediastinal or periesophageal tuberculous lymphadenitis.View full abstractDownload PDF (6887K) -
Mitsuhiro USHIO2005 Volume 80 Issue 7 Pages 541-546
Published: 2005
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculosis Control Law, which provides a legal basis for national tuberculosis control, was amended in 2004and entered into force on April 1, 2005. As it is more than half a century since its initial enactment, the law has been drastically amended based on some of the relatively new important ideas such as up-to-date scientific evidence, recent epidemiological conditions of tuberculosis, decentralization and respect for human rights.
Japan has once seen a time when considerable part of producing population were affected with tuberculosis which caused severe infliction on the whole Japanese society including economical damage. With progress in medical technology such as development of chemotherapy and improvement of sanitary conditions, there was a major decline in incidence rate and death rate during the 1960s and 1970s. However, the decrease in TB incidence began to stagnate in the 1980s, partly explained by aging of the overall society and worsening of the urban tuberculosis conditions.
Since then, there has be en a discussion on review of national tuberculosis control program, and the increase in the number of tuberculosis patients in 1997, which happened for the first time in 38 years, precipitated the process. In 1999, ‘Tuberculosis Emergency Declaration’ was announce d by the Minister of Health, which led to emergency national tuberculosis survey in 2000, and based on the result came forward the Recommendation on Comprehensive Review of National Tuberculosis Plan. Main ideas and spirits of the Recommendation were taken full account of during the process of the amendment of the law and were mostly reflected on the final outcome. Five key elements include; Establishment of National Tuberculosis Fundamental Guideline and Prefectural Tuberculosis Prevention Plan, Review on TB screening, Review on BCG vaccination policy, Promotion of a Japanese version of DOTS, Review on Tuberculosis Advisory CommitteeView full abstractDownload PDF (1173K)
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