Kekkaku : [Tuberculosis]
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Chest X-ray examination had been used rather soon after the discovery of X-ray by Rontgen K in 1895 as it was possible to detect chest abnormality by simple radiography. After the discovery of radiophotography independently by Abreu M and Koga Y in 1936, it was applied as a method of mass screening for TB in Japan, and Imamura A made a special lecture on "The mass screening for TB" using radiophotography in 1940 in the Annual Meeting of the Japanese Society for TB. From experiences of mass screening, it was found that there were many cases of TB who do not aware of their own disease, and to know the prevalence of TB, the screening of survey subjects by X-ray examination is indispensable. ⋯ In the age groups above 40, the prevalence of any TB finding, as well as of healed and calcified findings was very high, while the coverage of BCG vaccination was below 20%. BCG vaccination was started in Japan in 1943, and those above 40 years of age in 1963 were then already 20 years of age or above, and only few were vaccinated with BCG when BCG vaccination was expanded to cover higher age groups thereafter. TB prevalence survey has now come to be used as one of methods to estimate the incidence of TB under the impact of HIV/AIDS epidemic, and its significance is now re-evaluated.
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Kekkaku : [Tuberculosis] · Oct 2009
Case Reports[A case of tuberculosis with multiple lung nodules, abdominal lymphadenopathy, and splenomegaly].
Abdominal tuberculous lymphadenitis is very rare. We report a case of pulmonary tuberculosis showing marked abdominal lymphadenopathy and splenomegaly. A 95-year-old man was admitted to our hospital because of abnormal chest X-ray and body weight loss in last 6 months. ⋯ The patient was diagnosed as pulmonary tuberculosis, but about abdominal lymphadenopathy and splenomegaly we had to differentiate malignant lymphoma, and for definite diagnosis, laparotomy was necessary. But considering his age and general condition, we followed up carefully with anti-tuberculosis therapy. Pulmonary tuberculosis, abdominal lymphadenopathy and splenomegaly all showed marked improvement 4 months after starting anti-tuberculosis therapy with isoniazid, rifampicin, and ethambutol, so we clinically diagnosed abdominal tuberculous lymphadenitis and splenic tuberculosis.
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Kekkaku : [Tuberculosis] · Jul 2009
[Tuberculosis among the socially vulnerable populations; perspectives from human security concept].
Tuberculosis (TB) has been and will continue to be the disease of the poor and the socially vulnerable. Current TB epidemiology in Japan shows increasing proportion of TB among the economically and socially poor or vulnerable populations. Though there is no universally recognized set of the definitions, the economically poor who are covered under the social security services including the homeless, foreign migrants, or the aged over 80 years may be considered as consisting the "socially vulnerable population" for TB in Japan. ⋯ Further effort will be needed to reorient TB programs towards the perspective of patients' empowerment. Solely relying on static analyses of TB among the socially vulnerable has its limitations. Dynamic approach, which utilizes human security concepts such as empowerment and patients' perspective, will be required not only to control TB among the socially vulnerable population but also to holistically tackle the problem of TB for Japan.
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The Japanese version of DOTS seems to have established itself. However, there is criticism that the primary purpose of DOTS expansion has often been supplanted by pressure to meet a quota. In this symposium, we returned to the starting point of DOTS, i.e., seeking a total cure of TB patients, and rededicated ourselves to our ultimate goal--TB elimination. ⋯ The outpatient DOTS conference is a place where public health centers and clinics can share information on treatment and adherence support. Patient support under community DOTS targeting outpatients who do not need hospitalization requires closer cooperation between public health centers and related organizations now more than ever before. From the point of view of continuing treatment, it is thought necessary to focus on young Japanese patients, not just foreign-born patients.
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The progress of genomic analysis in mycobacterium including M. tuberculosis (Mtb) allowed us to find Mtb-specific antigens, ESAT-6 and CFP-10, which induce strong interferon-gamma (IFN-gamma) from sensitized T cells. Shortly after discovery of these antigens, diagnostic tests for tuberculosis (TB) infection were developed using these antigens. Since ESAT-6 and CFP-10 are absent from all BCG substrains and most of non-tuberculous mycobacterium, these diagnostic tests are not confounded with BCG vaccination and infection of most of non-tuberculosis mycobacterium. ⋯ In this mini-symposium, data on several questions in the QFT-2G test were presented. These included the application of QFT-2G to vulnerable individuals in immune system such as infants and HIV-positives, the effects of chemotheraphy on the QFT-2G test, the prognosis of development of active TB by QFT-2G, the next generation of QFT-2G, quality assurance of the QFT-2G test, and some problems of the current QFT-2G test. It should be important to research these questions and improve IGRAs based on the basic immunology.