[Objectives] To investigate gender difference in index and secondary patients with or without household contact.
[Subjects and Methods] The subjects of this retrospective study were 3, 174 pulmonary TB patients registered in Aichi prefecture between 1989 and 2003. All recorded files were reviewed to identify epidemiologically-related TB patient clusters. In case of epidemiologically-related patients registered within less than 10 years interval, the first registered patients was defined as the index case of the cluster. The other patients in the cluster were defined as secondary cases. Therefore, all pulmonary TB patients were classified to index, secondary, or unclustered cases. An index patient with sputum smear positive was defined as the source of transmission in the cluster. The male/female ratio was calculated separately in the sources and secondary patients with or without household contact.
[Results] A total of 100 source patients were identified. Of these, 77 were male and 23 were female, and the male/female ratio was 3. 3. The secondary patients were 153, of whom 77 were male and 76 were female, and the male/female ratio was 1. 0. The difference of the male/female ratio was statistically significant (p < 0. 001).
The male/fem ale ratio in the source patients was 2. 5 for 78 clusters with household contact and 21. 0 for 22 clusters without household (p< 0. 05), while the ratio in the secondary patients were 0. 8 and 2. 2 respectively (p< 0. 01). Of the 111 secondary patients with household contact, the relations to the source patients were wife-husband in 32, parent-child in 55, brother or sister in 12, grandparent-grandchild in 8, and the others in 4. In the 32 wife-husband transmission, most secondary patients were female (male/female = 9/23) while in other 67 transmissions with household contact, male and female secondary cases were almost same (male/female= 39/40). The male/female ratios in these two settings were significantly different (0. 4 vs 1. 0, p< 0. 05). Of the 42 secondary patients without household contact, transmission were occurred in working places in 24, schools in 11, religion circles in 4, hospital in one, and others in 2. The male/female ratio of secondary cases was 7. 0 for transmission at working places, and 0. 8 for transmission at the other places (p< 0. 01).
[Conclusion] These findings suggest that the male/female ratio of secondary patients with household contact is significantly lower than that of those without household contact.

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[Purpose] To study the frequency and degree of liver damage as adverse effect of isoniazid (INH) preventive therapy in Japanese people.
[Object and Metho d] Chart review of Japanese persons who started isoniazid preventive chemotherapy in the two clinics in Tokyo, from 2003/1/1 to 2004/12/31.
[Result] There were 77 9 cases who did not transiently or completely stop INH preventive therapy because of adverse effect, and 26 cases who stopped INH transiently or completely because of liver damage as adverse effect (total 805 cases). In 371 cases, of those 779 cases, AST (asparate aminotransferase) and ALT (alanine aminotransferase) was measured after starting INH at least once. In 14. 9% (59/397) of these 391 cases ( =371 + 26), liver damage as adverse effect was found. In 1. 51 % (6/397), liver damage with AST and/or ALT higher than 400 11U/L was found. Clinical hepatitis, associated with clinical symptom of hepatitis, was seen in 0. 37% (3/805). Hepatitis with liver failure was seen in 0. 12%. There was no death due to liver damage.
[Conclusion] Li ver damage as adverse effect of isoniazid (INH) preventive therapy in Japanese people is not rare.

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A case of tuberculous psoas abscess complicated during antituberculosis therapy for miliary tuberculosis and successfully treated with surgery was reported. A 20-yearold man visited our hospital because of fever lasting for 3 months. Chest radiography showed miliary nodules in both lungs and transbronchial lung biopsy revealed granuloma. Magnetic resonance imaging of the head showed small lesions in the brain. Computed tomography of the abdomen showed an enlarged paraaortic lymph node and a nodule in the spleen. Needle biopsy of the lymph node revealed necrotic tissue. Mycobacterium tuberculosis was not isolated; however, miliary tuberculosis was highly suspected based on clinical and radiographic findings. Once antituberculosis therapy was initiated with isoniazid, rifampicin, streptomycin, and pyrazinamide, the fever subsided. In spite of improvement of general radiographic findings, a new abscess was found in the right psoas major muscle after 8 months of therapy by computed tomography. A sample of the abscess showed a positive smear, negative culture, and positive PCR test for M. tuberculosis. Although antituberculosis therapy continued for another 6 months, the abscess enlarged to 7 cm and new retroperitoneal lymph nodes also appeared. Surgical drainage and curettage of the abscess was performed. Intra- and postoperative specimens were negative for bacteria, fungi, and M. tuberculosis. The patient was treated with isoniazid, rifampicin, and ethambutol for one year postoperatively. The disease disappeared without any evidence of relapse for 2. 5 years after surgery.

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In February 2005, a 33-year-old man visited A hospital complaining of fever. The blood screening test revealed the liver dysfunction, then computed tomography showed swelling of abdominal lymph nodes. In April, headache and disorientation appeared. He was diagnosed as disseminated tuberculosis and tuberculous meningitis based on chest X-ray and computed tomography findings and examination of cerebrospinal fluid. After admission to our hospital, anti-tuberculous drugs were prescribed, but the cerebral infarction happened. The disturbance of consciousness and the left half of his body paralysis appeared. They did not improve and hydrocephalus was complicated in August, though he was treated by steroids. He needed all helps because of the left half of his body paralysis and an advanced sequelae was left. It was thought that the abdominal lymph adenopathy preceded as one of symptoms of the disseminated tuberculosis in this case. It is said to be rare that abdominal lymph node swelling is seen in the early stage of disseminated tuberculosis. But, we think that it is necessary to keep in mind that the possibility of disseminated tuberculosis as one of the diseases in differential diagnosis, when we examine enlargement of abdominal lymph nodes with symptoms suggesting the presence of infection such as fever.

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Millions of people, mostly in Africa and Asia, die of the main infectious diseases such as tuberculosis, AIDS and malaria every year. In this talk, based on my experience in addressing global public health issues of the infectious diseases, I summarized key points to a successful international health initiative, and outlined achievements and problems in the global control strategy of tuberculosis, AIDS and malaria.

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