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Abstract [Objectives] Owing to limited evidence, the risk of and factors related to tuberculosis (TB) infection among care workers is not understood. We experienced an outbreak of TB with 2 cases of active TB (positive cultures) and 34 cases of latent TB infection at a care facility for the elderly. Using an epidemiological investigation of the outbreak, this study aimed to investigate the risk of and factors related to TB infection among care workers and to establish a system for TB control in care facilities for the elderly.

 [Subjects and Methods] The index patient (80-year-old woman; fever for 1.5 months) was diagnosed with TB [bI3: GAKKAI classifi cation, sputum smear (3+)]. We investigated the contacts of the patient. On the basis of the epidemiological investigation, we conducted a contact examination of close contacts, including those of residents and care workers at the care facility and staff at the medical facility to which the patient was referred. Reviewing this information, we compared both the results of the QuantiFERON®-TB Gold (QFT-GIT)

test and the degree of contact in 10 care workers and 7 nurses who had close contact while providing care services to the patient.

 [Results] The QFT-GIT test was conducted twice: 3 weeks and 11_12 weeks after the last contact with the patient. The number of care workers who tested positive while providing care services to the patient were 3, 0, and 5 according to the contact time of <20 h, 20 to <40 h, and 40 to <60 h, respectively. In addition, one equivocal result was found in the <20 h group. Equivocal results were noted in 1, 1, and 0 nurses, respectively. Only care workers tested positive using the QFT-GIT test, and one developed active TB. Each of the care workers spent approximately 50 min daily in planned care service to the patient, while each of the nurses spent approximately 20 min for the same. Care workers provided daily care services such as feeding, changing the patient’s posture, turning in bed, diaper changing, bathing, and

pro-viding a bed bath, and nurses provided services such as the measurement of vital signs, hydration, administration of medi-cation, and exchange of cooling material for lowering body temperature. In addition, care workers had been in contact with the patient while providing care services before the patient developed fever, and nurses initiated contact with the patient for care after the fever developed. With regards to daily health monitoring, the staff of the care facility had not monitored the patient for fever, loss of appetite, and/or weight loss before the fever became apparent. On the basis of these results, we suggest that the risk of TB infection is higher in care workers than in nurses because they work in close proximity (with body contact) with the patient for a longer period of time during the infectious period, including the asymptomatic period.

 To reduce the risk of TB infection in care workers, it is important to establish early detection systems in care facility residents by improving compliance with TB preventive meas-ures, including routinely conducting closer observation of these health conditions.

 [Conclusions] The high rate of infection among care workers may have been related to the longer period of close contact while caring for the patient. To reduce such risks, it is impor-tant to establish an early detection system for TB preventive measures in care facilities for the elderly.

Key words: Care facility for the elderly, Outbreak, Risk of TB infection, Care worker, QuantiFERON®-TB Gold

(QFT-GIT), Contact examination

Iwate Prefectural Miyako Public Health Center

Correspondence to : Hiroki Yanagihara, Iwate Prefectural Chubu Public Health Center, 1_ 44, Kajomachi, Hanamaki-shi, Iwate 025_ 0075 Japan.

(E-mail: h-yanagihara@pref.iwate.jp) −−−−−−−−Original Article−−−−−−−−

RISK OF TUBERCULOSIS INFECTION AMONG CARE WORKERS

DURING AN OUTBREAK OF TUBERCULOSIS

AT A CARE FACILITY FOR THE ELDERLY

Hiroki YANAGIHARA におけるチェックリストの有用性の検討. 環境感染 誌. 2012 ; 27 : 273 277. 20) 風間晴子, 濁川博子, 柏真知子, 他:感染曝露後 1 年間 QFTで経過観察しえた61名の医療施設内の結核曝露事 例─第2報 感染曝露後のQFT応答の推移. 結核. 2013 ; 88 : 411 416.

21) Dorman SE, Belknap R, Graviss EA, et al: Interferon-γ Release Assays and Tuberculin Skin Testing for Diagnosis of Latent Tuberculosis Infection in Healthcare Workers in the United States. Am J Respir Crit Care Med. 2014 ; 189 : 77 87.

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結核 第 89 巻 第 7 号 2014 年 7 月 642

Abstract [Objective] To evaluate serum surfactant proteins A and D (SP-A and SP-D), KL-6, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as biomarkers for monitoring the activity of pulmonary tuberculosis.

 [Methods] Patients with recently diagnosed and sputum smear-positive pulmonary tuberculosis were consecutively recruited between February and April 2013 at the Kanagawa Cardiovascular and Respiratory Center. Serum levels of SP-A, SP-D, KL-6, and CRP, and ESR were measured twice before treatment initiation and after confi rmation of disease improve-ment (indicated by two consecutive negative smears or one negative sputum culture). The relationship of those biomarkers with disease activity was evaluated by comparing the baseline values with the biological and radiological disease severities and by assessing the changes in those values before and after treatment.

 [Results] Twenty-seven patients with pulmonary tubercu-losis were enrolled in the study. The median age was 66 years, and the male/female ratio was 19/8 for the entire cohort. The baseline levels of most biomarkers signifi cantly or relatively increased in patients with severe biological and radiological outcomes, which were indicated by fi ndings such as long-term positive sputum culture, and the presence of cavities and

shadows on chest radiographs. A second measurement of these biomarkers was performed after a median treatment period of 56 days. The changes in the median levels for these biomarkers were as follows (before/after treatment): SP-A (ng/mL), 55.3/ 39.2 (p<0.01); SP-D (ng/mL), 71.5/38.5 (p=0.03); KL-6 (U/ mL), 365/374 (p=0.43); CRP (mg/dL), 3.8/0.4 (p<0.01); ESR (mm/hr), 69/46 (p=0.27). After treatment, the levels of SP-A, SP-D, and CRP signifi cantly decreased.

 [Conclusion] The levels of SP-A, SP-D, and CRP refl ected not only the baseline values but also the chronological disease activity. Therefore, these biomarkers could be useful for the management of pulmonary tuberculosis.

Key words: Pulmonary tuberculosis, Surfactant protein A, Surfactant protein D, KL-6, Biomarker

Department of Respiratory Medicine, Kanagawa Cardiovas-cular and Respiratory Center

Correspondence to: Yasunori Enomoto, Department of Res-piratory Medicine, Seirei Mikatahara General Hospital, 3543, Mikatahara-cho, Kita-ku, Hamamatsu-shi, Shizuoka 433_ 8558 Japan. (E-mail: yasuyasuyasu29@yahoo.co.jp) −−−−−−−−Original Article−−−−−−−−

COMPARISON OF BIOMARKERS OF PULMONARY TUBERCULOSIS ACTIVITY

─ Serum Surfactant Proteins A and D, KL-6, C-Reactive Protein, and Erythrocyte Sedimentation Rate ─

Yasunori ENOMOTO, Eri HAGIWARA, Shigeru KOMATSU, Ryuichi NISHIHIRA, Tomohisa BABA, and Takashi OGURA

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結   論  LVFX は結核患者に安全に長期使用できると考えられ たが,関節痛については注意が必要である。  本研究参加施設は以下のとおり。独立行政法人国立病 院機構(以下 NHO)旭川医療センター,NHO 茨城東病 院,NHO 東京病院,東京都立多摩総合医療センター,公 益財団法人結核予防会新山手病院,公益財団法人結核予 防会複十字病院,川崎市立井田病院,NHO 西新潟中央病 院,NHO 富山病院,地方独立行政法人大阪府立病院機構 大阪府立呼吸器アレルギー医療センター,NHO 松江医 療センター,NHO 東広島医療センター,NHO 愛媛病院, NHO 福岡東医療センター,NHO 大牟田病院,NHO 西別 府病院,NHO 南九州病院,NHO 宮崎東病院。

 著者の COI(confl icts of interest)開示:本論文発表内

容に関して特になし。 文   献 1 ) 日本呼吸器病学会呼吸器感染症に関するガイドライン 作成委員会:成人市中肺炎ガイドライン. 日本呼吸器 病学会, 東京, 2007, 40. 2 ) 多田敦彦, 河田典子, 柴山卓夫, 他:多剤耐性結核に 対する ofl oxacin, 1evofl oxacin の in vitro 抗菌活性と臨床 効果. 結核. 2006 ; 81 : 337 344.

3 ) Treatment of tuberculosis Guidelines 4th ed. WHO, Geneva, 2010, 84.

4 ) American Thoracic Society, CDC, and Infectious Dis-eases Society of America : Treatment of Tuberculosis, Am J Respir Crit Care Med. 2003 ; 167 : 603 662.

5 ) 日本結核病学会治療委員会:「結核医療の基準」の見 直し─ 2008 年 . 結核 . 2008 ; 83 : 529 535.

6 ) 日本結核病学会治療委員会:結核に対するレボフロキ サシンの使用実態調査結果 . 結核 . 2012 ; 87 : 599 608.

Abstract [Background] The safety of the long-term use of levofl oxacin as an antibiotic has not previously been reported via a prospective study. This lack of evidence acts as a barrier for its use as an anti-tuberculosis drug.

 [Method] Cases with long-term levofl oxacin use were prospectively followed at member hospitals of Ryoken. The frequency of adverse events is reported.

 [Results and discussion] Of 91 total cases, 7 cases were reported to have adverse drug reactions that may or may not have been levofl oxacin-related. Of these 7 cases, 5 reported arthralgia and muscle pain that occurred 37_157 days after starting levofl oxacin. Of 49 bacillary-positive cases, 1 case died 1 month later, 1 case did not have a culture examination,

and 47 cases showed culture conversion.

 [Conclusion] Long-term levofl oxacin use is likely to be safe; however, arthralgia should be monitored in these long-term users.

Key words: Levofl oxacin, Long-term use, Adverse reactions, Tuberculosis, New quinolone

Correspondence to: Takashi Yoshiyama, Ryoken, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Associa-tion, 3_ 1_ 24, Matsuyama, Kiyose-shi, Tokyo 204_ 8533 Japan. (E-mail: yoshiyama@jata.or.jp)

−−−−−−−−Original Article−−−−−−−−

PROSPECTIVE ANALYSIS OF ADVERSE REACTIONS WITH

LONG-TERM LEVOFLOXACIN USE

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結核 第 89 巻 第 7 号 2014 年 7 月 654

Abstract [Objective] To clarify the occurrence and clinical characteristics of tuberculosis among home medical care patients, we conducted a retrospective study of patients who received home medical care from our hospital.

 [Subjects and Methods] We investigated 502 patients (mean age, 79.5 years) who received home medical care from our hospital between January 2003 and December 2012. The newly notifi ed tuberculosis cases aged ≧70 years in the general population in Miyagi were defi ned as the control group. Among the patients receiving home medical care, we evaluated the clinical characteristics of the patients with tuberculosis.  [Results] Four of the 502 patients (0.8%) developed tuberculosis. Using the person-years method, the case rate of tuberculosis was calculated as 298.3 per 100,000 among home medical care patients. Compared with the control group, home medical care patients had a greater incidence of tuberculosis (298.3 vs. 36.06; rate ratio, 8.27; 95% confi dence interval, 3.06_22.3; p <0.001). When home medical care patients visited the hospital or were transported there by ambulance,

they were initially often diagnosed with aspiration pneumonia. Moreover, the time interval to the onset of disease from the introduction of home medical care varied among cases (3_192 months).

 [Conclusion] Patients receiving home medical care are at high risk of contracting tuberculosis. Therefore, for the medical staff involved in treating home medical care patients, the onset of tuberculosis should be carefully considered in daily medical practice.

Key words: Mycobacterium tuberculosis, Home medical care, High-risk group, Active case fi nding

Department of Respiratory Medicine, Saka General Hospital Correspondence to: Satoshi Ubukata, Department of Respira-tory Medicine, Saka General Hospital, 16_ 5, Nishiki-cho, Shiogama-shi, Miyagi 985_ 8506 Japan.

(E-mail: ubuka-ta@zmkk.org) −−−−−−−−Original Article−−−−−−−−

OCCURRENCE AND CLINICAL CHARACTERISTICS OF TUBERCULOSIS

AMONG HOME MEDICAL CARE PATIENTS

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

宅 医 療 の 状 況」. http://www.mhlw.go.jp/toukei/saikin/hw/ kanja/11/dl/01.pdf/(2014 年 2 月 16 日アクセス) 3 ) 大森正子, 和田雅子, 吉山 崇, 他:老人保健施設に おける結核の早期発見に影響する要因. 結核. 2003 ; 78 : 435 442. 4 ) 加治木章, 石川信克:高齢者の結核対策(第 78 回総会 シンポジウム). 結核. 2004 ; 79 : 55 58. 5 ) 星野斉之, 大森正子, 内村和宏, 他:高齢者結核の疫 学的検討. 結核. 2008 ; 83 : 423 429. 6 ) 久場睦夫, 仲宗根恵俊, 宮城 茂, 他:活動性肺結核 患者における死亡症例の臨床的検討. 結核. 1996 ; 71 : 293 301. 7 ) 田村猛夏, 白山玲郎, 笠原礼子, 他:活動性肺結核と 基礎疾患の関連性について. 結核. 2001 ; 76 : 619 624. 8 ) 網島 優, 岸不盡彌, 鎌田有珠, 他:過去 5 年間の当 院における結核早期死亡例の背景因子の検討. 結核. 1998 ; 73 : 727 731. 9 ) 黒田文伸, 山岸文雄, 佐々木結花, 他:入院時 Perfor-mance Status 不良の高齢者肺結核の臨床的検討. 結核. 2002 ; 77 : 789 793. 10) 大森正子, 和田雅子, 御手洗聡, 他:老人保健施設入 所者の結核対策─リスクマネージメントの視点で. 結 核. 2006 ; 81 : 71 77.

11) Wang J-Y, Hsueh P-R, Jan I-S, et al. : Empirical treatment with a fl uoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas. Thorax. 2006 ; 61 : 903 908.

12) Dooley EK, Golub J, Goes FS, et al. : Empiric treatment of community-acquired pneumonia with fl uoroquinolones, and delays in the treatment of tuberculosis. CID. 2002 ; 34 : 1607 1612.

13) Grossman RF, Hsueh P-R, Gillespie SH, et al. : Community-acquired pneumonia and tuberculosis : differential diagnosis and the use of fl uoroquinolones. IJID. 2014 ; 18 : 14 21. 14) 伊藤邦彦:結核臨床医から見た市中肺炎診療ガイドラ

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−−−−−−−−Short Report−−−−−−−−

COMPARISON OF TESTS RESULTS BETWEEN T-SPOT

®

.TB AND

QuantiFERON

®

-TB GOLD IN-TUBE IN A CONTACT INVESTIGATION

1Haruko MUKOUYAMA, 2Kazue HIGUCHI, and 2Nobuyuki HARADA Abstract [Background] We compared T-SPOT®.TB

(T-SPOT) and QuantiFERON-TB Gold In-Tube (QFT-GIT) test results in a contact investigation.

 [Subjects and Methods] The index case was a male lecturer at a vocational school in Tokyo. Chest X-ray examinations and T-SPOT tests were performed on all 397 contacts, and QFT-GIT was performed on a subset of these contact subjects.  [Results] Chest X-ray examination showed no evidence of tuberculosis in any subjects. Among 389 contacts that underwent T-SPOT testing, 5 showed a positive reaction, 3 showed borderline reactions (1 positive borderline and 2 negative borderline), and 381 were negative. Among 56 contacts tested using both QFT-GIT and T-SPOT, 4 were positive, 1 was borderline, and 51 were negative by QFT-GIT. By T-SPOT, 2 contacts were positive, 1 was borderline positive, and 53 were negative. Preventive chemotherapy was indicated for the 5 positive and 1 borderline positive contacts identifi ed by the T-SPOT test.

 [Discussion] Chest X-ray examination and the T-SPOT test did not identify the TB outbreak.

 [Conclusion] The majority of contact subjects were negative by both tests, suggesting that both have a high specifi city in contact investigations. However, the moderate concordance rate indicates that further testing is necessary to fully evaluate these tests.

Key words: IGRA, T-SPOT.TB, QFT-3G, Contact investi-gation, Latent tuberculosis infection

1Nakano City Public Health Offi ce, 2Research Institute of

Immune Diagnosis

Correspondence to : Haruko Mukouyama, Machida City Public Health Offi ce, 2_ 13_ 3, Naka-machi, Machida-shi, Tokyo 194_ 0021 Japan.

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Tenosynovitis during Antituberculous Therapy / K. Yamamoto et al. 665

Abstract The adverse effects of anti-tuberculosis agents is an important problem for treatment of tuberculosis. We report 2 possible cases of isoniazid-induced tenosynovitis.

 Case 1: A 49-year-old man with untreated diabetic mellitus presented with hypesthesia and diffi culty grasping with his right hand 1 month after starting treatment of tuberculosis of the lung and pleuritis using isoniazid, rifampicin, ethambutol, and pyrazinamide. His symptoms were due to tenosynovitis, which was detected by magnetic resonance imaging. The clinical course and isoniazid challenge test revealed that the condition was related to isoniazid. After discontinuing isonia-zid treatment, his symptoms gradually improved.

 Case 2: An 78-year-old man operated on for rectal cancer 3 weeks previously presented with edema and arthralgia of both hands 1 month after starting anti-tuberculosis treatment. His tuberculosis was diagnosed at preoperative screening tests for rectal cancer. Owing to a medical history of gout, pyrazinamide was discontinued. However, his symptoms did not improve. Magnetic resonance imaging revealed fi ndings indicative of tenosynovitis. At the end of anti-tuberculosis treatment, his

symptoms improved slightly within 6 months.

 Isoniazid-induced tenosynovitis and arthritis are rare ad-verse effects. However, they may be underestimated because the severity is variable. We suggest further investigations of the side effects of isoniazid using imaging techniques such as magnetic resonance imaging.

Key words: Isoniazid, Tenosynovitis, Complications of bone and joint during antitubecular treatment, MRI

1Division of Infectious Diseases, 2Department of Respiratory

Medicine, National Center for Global Health and Medicine,

2Department of Respiratory Medicine, National Hospital

Organization Tokyo National Hospital

Correspondence to: Kei Yamamoto, Department of Respira-tory Medicine, Division of Infectious Diseases, National Center for Global Health and Medicine, 1_21_1, Toyama, Shinjuku-ku, Tokyo 162_8655 Japan.

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

TENOSYNOVITIS CONFIRMED BY MRI DURING ANTI-TUBERCULOUS

TREATMENT SUSPECTED DUE TO ISONIAZID

─ 2 Case Reports and Literature Review ─

1, 2Kei YAMAMOTO, 2Jin TAKASAKI, 2Eriko MORINO, 3Nobuyuki KOBAYASHI,

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Abstract [Objectives] In order to improve the appropriate-ness of contact examinations, we investigated the characteris-tics of secondary tuberculosis cases.

 [Subjects and Methods] We included tuberculosis patients that were located in Kawasaki City between 2008 and 2011. The patients were considered as 2 separate groups: those with tuberculosis following contact with index cases registered in Kawasaki City and those with tuberculosis who were located in Kawasaki City. Secondary cases were defi ned as subjects who underwent a contact examination and developed active tuber-culosis within 2 years from the last contact with the index case. The secondary cases were classifi ed by diagnostic method, time, and sputum smear test results, followed by consideration of improvement measures.

 [Results] There were 1196 tuberculosis patients and 6157 subjects who underwent a contact examination. Of these, 35 patients developed tuberculosis secondary to index cases registered in Kawasaki City. These 35 cases were classifi ed by diagnostic methods. Diagnosis occurred during a contact examination in 31 cases and during a symptomatic visit in 4 cases. There were 2 sputum smear-positive patients detected in a contact examination that was conducted ≧6 months after contact. These 2 cases had a symptomatic cough, but did not visit a medical institution. There were 39 patients with sec-ondary tuberculosis who were located in Kawasaki City. These 39 cases were also classifi ed by diagnostic methods. Diagnosis

occurred during a contact examination in 33 cases and during a symptomatic visit in 6 cases. There were 4 sputum smear-positive patients detected in a contact examination that was conducted ≧6 months after contact. These 4 cases had a symptomatic cough, but did not visit a medical institution.  [Discussion] Of the secondary cases, a sputum smear-positive state was detected in some of the patients at the time of a contact examination that was conducted ≧6 months after contact. However, secondary cases should be discovered at a sputum smear-negative stage. Appropriate education regarding the importance of a medical visit at the onset of symptoms could decrease the number of patients that are identifi ed in the sputum smear-positive state during a contact examination that occurs at least 6 months after contact.

Key words: Public Health Center, Contacts examination, Symptomatic visit, Secondary cases, Sputum smear-positive

1Kawasaki Tama Public Health Center, 2Kawasaki Nakahara

Public Health Center, 3Kawasaki Asao Public Health Center, 4Kawasaki Public Health Center

Correspondence to : Masamichi Nishimura, Kawasaki Tama Public Health Center, 1775_ 1, Noborito, Tama-ku, Kawasaki-shi, Kanagawa 214_ 8570 Japan.

(E-mail: nisimura-m@city.kawasaki.jp) −−−−−−−−Field Activities−−−−−−−−

IMPORTANCE OF A SYMPTOMATIC VISIT IN TUBERCULOSIS CONTACTS

─ Classifi cation of Secondary Cases ─

1Masamichi NISHIMURA, 2Koji MAGAWA, 3Yoko MATSUSHITA, and 4Isamu WAKAO 触者検診基準の再検討─接触者検診の観察期間中に発 病した 5 症例の分析. 加齢医学研究所雑誌. 2001 ; 52 : 9 20. 10) 松本健二, 三宅由起, 有馬和代, 他:接触者健診にお ける発病例の検討. 結核. 2012 ; 87 : 35 40. 11) 松本健二, 三宅由起, 有馬和代, 他:潜在性結核感染 症治療状況の検討. 結核. 2010 ; 85 : 791 797. 12) 佐々木結花:結核患者発見の遅れの研究. 結核. 2002 ; 77 : 621 625. 13) 青木正和:スクリーニングにおける自覚症の位置づけ ─呼吸器の場合. 健康管理. 1973 ; 225 : 9 17. 14) 島尾忠男:喫煙と結核. 複十字. 2008 ; 324 : 21. 15) 森 亨編:「保健所における結核対策強化の手引きと その解説」. 結核予防会, 東京, 2000, 30 31. 16) 青木正和, 阿彦忠之, 森 亨:「結核定期外健康診断ガ イドラインとその解説」. 結核予防会, 東京, 1993, 37 42. 17) 川辺芳子, 片山 透, 芳賀敏彦:第 65 回総会ワークシ ョップ「ハイリスクからの結核・家族結核」. 結核. 1990 ; 65 : 674 677. 18) 結核予防会編:「感染症法における結核対策 保健所・ 医療機関等における対策実施の手引き」. 平成 25 年改 訂新版, 結核予防会, 東京, 2013, 75.

19) Rieder HL, Cauthen GM, Comstock GW, et al. : Epidemi-ology of tuberculosis in the United States. Epidemiol Rev. 1989 ; 11 : 79 98.

20) Bloch AB, Rieder H, Kelly GD, et al. : The epidemiology of tuberculosis in the United States. Semin Respir Infect. 1989 ; 4 : 157 170.

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678 結核 第 89 巻 第 7 号 2014 年 7 月

−−−−−−−−Report and Information−−−−−−−−

TUBERCULOSIS ANNUAL REPORT 2012

─ (2) Childhood and Elderly Tuberculosis ─

Tuberculosis Surveillance Center (TSC), RIT, JATA Abstract  In 2012, there were 63 newly notifi ed childhood

tuberculosis (TB) patients (patients aged 0_14 years) in Japan, corresponding to a notifi cation rate of 0.38 per 100,000. The annual number of notifi ed childhood TB patients was less than 100 in 2006, since then the numbers and rates (per 100,000 population) decreased steadily. Of the 63 patients with child-hood TB notifi ed in 2012, 30 (47.6%) were aged 0_4 years, 12 (19.0%) were aged 5_9 years, and 21 (33.3%) were aged 10_14 years. Thus, the proportion of TB patients aged 0_4 years was the highest among children. In 2012, only one patient of TB meningitis and no patient of miliary TB were reported in children. On the point of case detection, similar to percentages reported in previous years, 22 patients (34.9 %) were identifi ed at medical institutions and 32 patients (50.8 %) were detected by contact investigation of household members.

 Since 1999, the notifi cation rates of TB in Japan have been consistently higher among patients aged 85 years and above than among those aged 65_84 years in Japan. The annual rate of reduction in the notifi cation rates of TB patients aged 65 years and above in 2012 (13,307 cases) was 3.3%, compared to 2011 (13,756 cases). The proportion of TB patients aged 65 years and above has consistently increased, reaching up to 62.5% in 2012; notably, the proportion of TB patients aged 80 years and above has increased to 34.0%. The proportion of bacteriologically positive TB patients among pulmonary TB (PTB) patients was higher among those aged 65 years and above than among those aged 15_64 years. The proportion of

PTB patients with only non-respiratory symptoms increased with age, reaching 27.6% among those aged 85 years and above. The proportion of TB patients associated with patient delay of two months or longer was lower among the patients aged 65 years and above than among those aged 15_64 years (14.5% vs. 26.7%), whereas the proportion of TB patients associated with doctor delay of one month or longer was slightly higher among patients aged 65 years and above than among those aged 15_64 years (22.9% vs. 20.2%). Of the newly notifi ed TB patients aged 65 years and above in 2011 whose treatment outcomes were available at the time of reporting, 31.3% died within a year after the initiation of TB treatment; of these, 18.4% died within three months. The proportion of deaths within three months after the initiation of TB treatment among patients aged 65 years and above increased substantially with age from 8.1% in the 65_69 years age group to 31.9% in the 90 years and above age group. Key words: Tuberculosis, Notifi cation rate, Childhood tuber-culosis, Elderly tubertuber-culosis, Annual trend

Research Institute of Tuberculosis (RIT), Japan Anti-Tubercu-losis Association (JATA)

Correspondence to: Tuberculosis Surveillance Center (TSC), Research Institute of Tuberculosis (RIT), JATA, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan.

(E-mail: tbsur@jata.or.jp) は,常に結核を念頭に置いた患者ケアが必要である。  発生数がわずかとなった小児結核,患者数が多くまた 診断の遅れをきたしやすい高齢者結核いずれの対策にお いても,結核専門医療機関・一般医療機関・保健所との 診療協力,情報共有が不可欠である。 文   献 1 ) 結核研究所疫学情報センター:結核年報 2008 Series 3. 小児結核. 結核. 2009 ; 84 : 795 _ 798. 2 ) 結核研究所疫学情報センター:結核年報 2009 Series 3. 小児結核. 結核. 2011 ; 86 : 553 _ 556. 3 ) 結核研究所疫学情報センター:結核年報 2010(3)小児 結核. 結核. 2012 ; 87 : 549 _ 553. 4 ) 結核研究所疫学情報センター:結核年報 2011(2)小児 結核 ・ 高齢者結核. 2013 ; 88 : 611 _ 616. 5 ) 厚生労働省:定期の予防接種実施者数 平成 6 年法律開 始後(実施率の推移)http://www.mhlw.go.jp/topics/bcg/ other/5.html

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