[Objective] To observe the trends and methods of tuberculosis (TB) detection in different occupations; to estimate the incidence of TB among nurses, and calculate the relative risk by comparing with the aged-matched general population; and to estimate the incidence of TB and r elative risk also for teachers and doctors.
[Materials and Method s] The background of TB patients was analyzed using the annual reports of TB registry for the period between 1987 and 2004. The population obtained from the national census, which was conducted every five years, was used for the calculation of TB incidence by specific occupation. The annual population between the two census years was obtained by interpolation. The TB registry assigns the same occupation code for nurses, public nurses and nursery teachers, and similarly assigns a common code for teachers and medical doctors. Therefore, TB incidence of nurses was calculated by subtracting the estimated number in nursery teachers. The number of nursery teachers contracting TB was obtained assuming that their TB incidence was the same as that for the 20-59 year-old population of the same sex. On the other hand, TB incidence for teachers and doctors was calculated together, because of the difficulties in separating the two occupations.
[Results] Among nurses with TB, the proportion of cases detected by periodic mass screening in the workplace increased gradually from 21.4% in 1987 to 40.4% in 2004. Conversely, the proportion of cases detected by symptomatic vist to medical institutions declined from 69.4% in 1987 to 43.9% in 2004. In general population, the proportion of cases detected by contact tracing is low. Among nurses, however, cases detected by contact tracing had increased since around 1995; the proportion was 1-2% before 1995, increased to 7.0% in 1999and leveled off at around 6-9%.
TB incidence of female nurses declined slightly from 54.1per 100, 000 population in 1987 to 46.3 in 2004 (14.4%), and that of male nurses also declined from 127.0 in 1987 to 82.5in 2004 (35.0%). However, the relative risk of female nurses increased from 2.1 (95%0: 1.9-2.3) in 1987 to 4.3 (95%CI 3.9-4.8) in 2004, and that of male nurses also increased from 2.4 (95%0: 1.6-3.4) in 1987 to 3.8 (95%0: 2.8-5.2)in 2004. The relative risk had increased gradually from the middle of 1990s in both sexes.
TB incidence of female teachers and doctors decreased from 14.8 per 100, 000 population in 1987 to 10.0 in 2004(32.4%), and that of male teachers and doctors decre ased from 39.3 in 1987 to 18.8 in 2004 (52.2%). While the relative risk was below 1 in both sexes, the relative risk in females increased from 0.6 (95%CI: 0.5? 0.7) in 1987 to 0.8 (95%CI: 0.7-1.1) in 2004, and that in males also increased fro m 0.7(95%CI: 0.7-0.8) in 1987 t o 0.9 ( 95% C I: 0.8-1.0) in 20 04.
[Conclusion] Based on the relative risk data, approxim ately 80% of nurses with TB might have been infect ed by nosocomial infection and developed the disease. Since about half of them were detected in an early stage by mass screening in the workplace or contact tracing, TB control measures for nurses may be considered effective. However, the relative risk of TB among nurses had continued to increase without any trend of decline. The infection control at the hospitals may be inadequate, and should be reinforced by evaluating the methods or contents of control measures conducted so far.

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[Settings] Fukujuji Hospital, Japan.
[Purpose] To evaluate treatment resul ts of Rifampicin (R)resistant Isoniazid (H) susceptible tuberculosis cases.
[Method] Cohort analysis of twenty-three H susceptible R resistant tuberculosis cases started treatment in 1985-2004 at Fukujuji Hospital, by the retrospective review.
[Results] Three cases became Multi- drug resistant tuberculosis (MDR TB), seventeen cases were cured, two cases died, and one case transferred out. One started treatment with HR became MDR, one of the two started treatment with HR + Ethambutol (E) became MDR and one of them was cured, eight among ten cases started treatment with HR + Pyrazinamide + (Eor Streptomycine (5)) were cured, one among the ten died and one among the ten transferred out, one started treatment with RZE was cured, three among the five cases started treatment with three effective drugs without Z were cured, one among the five died, one among the five bec ame MDR. Three cases started treatment with four effective drugs were cured. Among the nineteen cases continued treatment for more than six months, ten cases treated with four or five effective drugs for at least two months were cured, two cases of nine cases treated with three drugs or less became MDR, seven of the nine cases were cured. Among the same nineteen cases, eleven cases not treated with two or less effective drugs were cured, one case treated with two or less effective drugs for six months became MDR and one of them treated with one or two effective drug for one to three months became MDR and some were cured. The used drugs were H, E, Pyrazinamide, Streptomycin, Kanamycin, Ethionamide and New Quinolones. The duration of treatment of cured cases were eleven to twelve months in 3 cases, twelve to eighteen months in 3 cases, eighteen to twenty-four months in 8 cases and more than two years in 3 cases.
[Conclusion] If the star ting regimen is HRZE, we can cure R resistant H susceptible tuberculosis by the use of four effective drugs for more than two months and at least three effective drugs with the total duration of treatment for twelve to twenty-four months.

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[Purpose] To make molecular epidemiological analysis of Mycobacterium k ansasii (Al, k ansasii) isolates.
[Methods] We examined 174 M. kansasii is olates from clinical samples of patients at National Hospital Organization Kinki-chuo Chest Medical Center from June 1, 2002 to August 31, 2005 by polymerase chain reaction (PCR) -restriction analysis (PRA) of the heat shock protein (hsp) 65 gene (hsp 65PRA), sequencing (ITS, 16S-23S internal transcribed spacer, and hsp 65 for discrepant case between hsp 65-PRA and ITS sequence), pulsed-field gel electrophoresis (PFGE), and restriction fragment length polymorphism (RFLP) with the major polymorphic tandem repeat (MPTR) probe and the IS 1652probe of genomic DNA.
[Results] Of the 174 M. kansasii isolates, 170 strains were classified as M. kansasii type I using hsp 65-PRA, while two isolates belonged to type II and one each isolate to type II b and VI, respectively. Although the ITS sequence of these isolates also identified the same region of polymorphism by hsp65-PRA, only type II b might be revealed atypical type II, a transitional type from typical type II to intermediate type I by hsp 65 sequence. The polymorphic patterns by RFLPs with MPTR and 1S1652 probe were shown specific for each homogeneous cluster by hsp 65-PRA. In addition, 159 isolates were recognized the same common pattern A by PFGE analysis. In contrast, the rest 15 isolates revealed significant polymorphism within 11 isolates of type I, and 4 isolates among type II, Ub, and VI.
[Discussion] W e verified the M. kansasii genotype I was predominant, with the same pattern of major worldwide type regions, and reflected a very tight clonal structure. Type I was furthermore indicated recognition of subtypes by PFGE analysis.

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This case is a 56-year old woman. Steroids were being administered perorally after a thymectomy for myasthenia gravis. A fever of 38-39 degrees Celsius appeared during night, an abnormal shadow showed up on a chest X-ray and the patient was hospitalized. Gaffky No.2 acid-fast bacilli were detected in the patient's sputum and the chest CT showed diffuse granular-like shadow, the patient was diagnosed as miliary tuberculosis and treatment with combined use of INH, RFP, EB, and PZA was started. Subsequently, fever started to subside and the miliary shadow on chest X-ray improved, however, six weeks after the start of treatment, hoarseness and dysphagia appeared. From the cervical CT and cervical angiography findings, the diagnosis of right subclavian artery impending ruptured aneurysm was made. Because the patient's sputum was acid-fast bacilli positive and because the patient had undergone thymectomy, it was decided that it would be difficult to treat her by a thoracotomy again. Therefore, a right subclavian artery stent insertion, right subclavian artery?right common carotid artery bypass creation operation was carried out with the objective of blocking the flow of blood to the aneurysm. The hoarseness and dysphagia improved post-operatively and the patient's progress is being monitored. Tuberculous aneurysms are a rare affection and they are mostly discovered when the autopsy is done, however, this case was diagnosed due to the manifestation of subjective symptoms. While this case was not diagnosed histopathologically, it is envisaged from the clinical progress that this was a tuberculous subclavian aneurysm complicated during the treatment for miliary tuberculosis.

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