August

全文

(1)

Trends of Foreign TB Patients / J. Otsuka et al. 437

Abstract [Purpose] In the present study, we clarifi ed the current problems of tuberculosis (TB) control in foreign-born patients by analyzing the trend and clinical characteristics of such patients in our hospital and using that data to create a plan to manage the expected future increase in foreign-born TB patients.

 [Subjects] We targeted foreign-born TB patients who received medical care in our hospital from January 2011 to December 2015.

 [Method] We examined their characteristics, such as birth country, occupation, period from entry to diagnosis, image fi ndings, and bacteria elimination status, according to medical records.

 [Results] The number of foreign-born TB patients was 42. The median age was 24 (range: 19_70) years old, and 34 (81.0%) were in their twenties. Among them, 28 (66.7%) were international students. The most common opportunity for diagnosis was a checkup examination, by which 23 (54.8 %) were diagnosed. Fifteen patients (35.7%) had cavities on a chest X-ray, and 22 (52.4%) patients tested positive for mycobacterium in a smear of sputum. The birth country of 18 patients was China (42.9%), and that of 17 patients was Nepal (40.5%). The number of patients from Nepal has increased. Twenty-two (52.4%) patients were diagnosed within one year of entry. There were some serial cases, such

as residents of the same house and students at the same school, and there were cases in which exogenous infections were suspected after entering Japan.

 [Conclusion] The number of foreign-born TB patients has increased. Immediate medical examination after entering Japan is important for tuberculosis control among foreigners, and it is also important to perform regular checkups through-out their stay in Japan in order to detect tuberculosis onset not only from previously infected but also newly infected after entering Japan.

Key words: Tuberculosis, Foreign nationals, International student, Language school, Health examination

1Department of Respiratory Medicine, National Hospital

Organization Fukuoka Higashi Medical Center; 2Department

of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital; 3Department of Respiratory

Medicine, St. Mary’s Hospital

Correspondence to: Junji Otsuka, National Hospital Orga-nization Fukuoka National Hospital, 4_39_1, Yakatabaru, Minami-ku, Fukuoka-shi, Fukuoka 811_1394 Japan.

(E-mail: ootsuka.junji.dx@mail.hosp.go.jp) −−−−−−−−Original Article−−−−−−−−

TRENDS AND CLINICAL CHARACTERISTICS OF FOREIGN-BORN

TUBERCULOSIS PATIENTS

1, 2Junji OTSUKA, 1, 3Yoritake SAKODA, 1, 2Kunihiro KUDO, 1Toyoshi YANAGIHARA, 1Satoshi IKEGAME, 1Kentaro TANAKA, 1Takako NAKANO, 1Michihiro YOSHIMI,

1Yoshiaki TAO, and 1Shohei TAKATA

的医薬品等開発推進研究事業(平成26 28年 「地域に おける結核対策に関する研究(研究開発代表者 石川 信克 」における分担研究「ハイリスク者の結核対策」 研究班:「日本語学校結核検診のあり方に関する提言」. 2017年. 17) 公益財団法人福岡県国際交流センター:外国人登録者 数・留学生に関するデータ. https://www.kokusaihiroba. or.jp/city/data.html(2018年11月25日閲覧) 18) e-Stat 政府統計の総合窓口(総務省)https://www.e-stat. go.jp/SG1/estat/eStatTopPortal.do(2016年5月5日閲覧) 19) 南埜 猛, 澤 宗則:日本におけるネパール人移民の 動向. 移民研究. 2017 ; 13 : 23 48.

20) World Health Organization: Global tuberculosis report 2015. 21) Gagneux S, DeRiemer K, Van T, et al.: Variable

hostpatho-gen compatibility in Mycobacterium tuberculosis. Proc Natl Acad Sci USA. 2006 ; 103 : 2869 2873.

22) 大石 明, 前田詠里子, 村上光一, 他:結核菌反復多型 VNTR)分析法を用いた福岡県における結核菌の遺伝 子型別. 結核. 2016 ; 91 : 569 577. 23) 村瀬良朗, 大角晃弘, 渡辺ゆう, 他:都市部における来 日外国人と地域住民間の結核感染動態に関する分子疫 学研究. 結核. 2017 ; 92 : 431 439.

(2)

Nationwide Survey of Anti-tuberculosis Drug Resistance in Japan / Ryoken 449

Abstract [Objective] To clarify the anti-tuberculosis drug resistance in Japan in 2012_2013 through 15th nationwide survey by Tuberculosis Research Committee (Ryoken).  [Method] A total of 8,681 Mycobacterium tuberculosis drug susceptibility testing (DST) data to isoniazid (INH), rifampicin (RFP), streptomycin (SM) and ethambutol (EB) was collected from 49 medical facilities in Ryoken consor-tium with confi rmed quality through external quality assur-ance. Accordingly, we could link a total of 2,560 patients clinical information with DST results utilising a part of National Epidemiological Surveillance of Infectious Diseases (NESID) system, and the drug susceptibilities were analysed according to the patients treatment history, nationality, comor-bidities and other factors.

 [Results] The combined/total frequencies of drug-resistant M. tuberculosis isolates were as follows; INH, 5.3% (95% CI, 4.8_5.8); RFP, 1.6% (95% CI, 1.3_1.8); SM, 7.2% (95% CI, 6.6_7.7); and EB, 1.9% (95% CI, 1.6_2.2). As to the linked data (n=2,560), the frequencies of drug-resistant isolates from new cases were as follows; INH, 4.2% (95% CI, 3.4_5.0); RFP, 1.3% (95% CI, 0.9_1.8), SM, 7.1% (95% CI, 6.1_8.2); and EB, 1.7% (95% CI, 1.2_2.3). The frequencies of drug-resistant isolates from previously treated cases were as follows; INH, 17.5% (95% CI, 11.7_25.3); RFP, 10.0% (95% CI, 5.8_16.7), SM, 15.0% (95% CI, 9.7_22.5); and EB, 8.3% (95 % CI, 4.6_14.7). The frequencies of multidrug-resistant M. tuberculosis isolates from new and previously treated cases

were 0.9% (95% CI, 0.6_1.4%) and 10.0% (95% CI, 5.8_ 16.7%), respectively. A signifi cant differences were observed in INH, RFP and SM resistances in new cases between domestic and foreign born patients.

 [Discussion] In the current study, INH showed a statistically signifi cant increase in combined and new resistances com-pared to those of 14th survey in 2007, as other drug resis-tances showed increasing trends. The foreign-born new tuber-culosis patients showed high drug resistances, compared to domestic patients. However, as to the analyses of 2,560 DST data with clinical information, the effective links of these data was limited to approximately 1/3 of total DST data collected, and the origins of linked data were mainly from Kanto and Kinki area. So the clinical analyses of the laboratory data will be representing some metropolitan area but not a whole country. It was a major limitation of this study, but the data will be useful to consider updated increasing trend of tuber-culosis drug resistances in Japan.

Key words: Mycobacterium tuberculosis, Drug susceptibility testing, External quality assessment, Drug resistance

Correspondence to: Satoshi Mitarai, Department of Myco-bacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan.

(E-mail: mitarai@jata.or.jp) −−−−−−−−Original Article−−−−−−−−

NATIONWIDE SURVEY OF ANTI-TUBERCULOSIS DRUG

RESISTANCE IN JAPAN: 2012_2013

Tuberculosis Research Committee (RYOKEN) 14) 結核予防会:結核の統計2012. 結核予防会, 2012.

15) 日本結核病学会抗酸菌検査法検討委員会:日本におけ る結核菌薬剤感受性試験外部精度評価の評価基準に関 する解析. 結核. 2015 ; 90 : 481 490.

16) World Health Organization: Technical Report on critical concentrations for drug susceptibility testing of medicines used in the treatment of drug-resistant tuberculosis. Geneva: World Health Organization; 2018 (WHO/CDS/TB/2018.5). Licence: CC BY-NC-SA 3.0 IGO.

17) Kawatsu L, Uchimura K, Izumi K, et al.: Profi le of tuberculosis among the foreign-born population in Japan,

2007 2014. WPSAR. 2016 ; 7 : 7 16. 18) 御手洗聡, 山田博之, 青野昭男, 他:結核菌のPyrazin-amide 感受性試験に関する外部精度評価. 結核. 2017 ; 92 : 519 527. 19) 豊田恵美子, 町田和子, 長山直弘, 他:高齢者結核の臨 床的検討. 結核. 2010 ; 85 : 655 660.

20) Tegegne BS, Mengesha MM, Teferra AA, et al.: Association between diabetes mellitus and multi-drug-resistant tubercu-losis: evidence from a systematic review and meta-analysis. Syst Rev. 2018 ; 7 : 161. doi : 10.1186/s13643-018-0828-0.

(3)

結核 第 94 巻 第 8 号 2019 年 8 月 456

Abstract [Background] This is a report of pyothorax-associated lymphoma (PAL), a diffuse large B-cell lymphoma (DLBCL) that developed in the pleural cavity after more than a 20-year history of pyothorax resulting from artifi cial pneumothorax treatment for pulmonary tuberculosis or tuber-culous pleuritis. The clinical course of PAL is not clear.  [Case] A 78-year-old man with right chest pain and bloody sputum entered our hospital. He had past history of tubercu-losis pleuritis at age 18, and resection of a right chest wall tumor at age 61. Chest computerized tomography (CT) on admission revealed a tumor of the right chest wall. A biopsy was performed, and was diagnosed as DLBCL, which we diagnosed as PAL. In addition, we reexamined the specimen collected at age 61, and identifi ed the same histopatholog-ical features in the new specimen.

 [Conclusions] This is the fi rst case report of heterochronic PAL, from which we could observe the process of PAL development for a 17-year period.

Key words: Pyothorax-associated lymphoma: PAL, Tuber-culosis, Diffuse large B-cell lymphoma: DLBCL, Epstein-Barr virus: EBV, Malignant lymphoma, Heterochronic

Department of Respiratory Medicine, Saka General Hospital Correspondence to: Daisuke Jingu, Department of Respira-tory Medicine, Saka General Hospital, 16_5, Nishiki-cho, Shiogama-shi, Miyagi 985_8506 Japan.

(E-mail: d.jinguuu@gmail.com) −−−−−−−−Case Report−−−−−−−−

A CASE OF HETEROCHRONIC PYOTHORAX-ASSOCIATED LYMPHOMA

WITH PAST HISTORY OF TUBERCULOUS PYOTHORAX

Daisuke JINGU, Takehiro YAJIMA, Satoshi UBUKATA, Makoto SHOJI, Kazuhisa KONISHI, and Hiroshi TAKAHASHI

Updating...

参照

Updating...

関連した話題 :