著者

島尾 忠男

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.77, no.1, pp.3-9, 2002-01-15

被引用文献数

3

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結核病床は, 昭和20年代にはまず自然療法の場, 次いで外科療法を含む積極的な治療の場として積極的に整備が進められ, 昭和33年には26万床強に達した。その後は, 対策の推進による結核患者数の急速な減少の影響を受け, 病床数が削減されてきたが, 治療の進歩による治療期間短縮の影響を受け, 入院期間も短縮されたため, 一部の地域を除いて空床が目立つようになってきている。結核病床の問題点としては, 近代化が行われず, 病棟単位で運営されてきたため, 整理統合が進むと, かなり離れた施設への入院を余儀なくされ, 病院職員に対する感染防止の配慮もされていない点が指摘される。<BR>今後の結核病床のあり方としては, 運営を病棟単位から病室単位に切り替え, 一般病院内にも隔離できる換気設備を持った急性期用結核病室を整備し, 都道府県内に適切に配置し, 従来の国立療養所には慢性化した患者のための病床も残す。新たに発見された患者に対する入院期間を短縮し, 入院中から確実な服薬を行う指導を始め, 外来治療に円滑なバトンタッチを行う。換気設備を持つ急性期用病室の整備に補助を行い, 急性期の診療に対しては適切な医療費を設定するべきである。

著者

福元 重太郎 猪島 一郎 藤田 昌樹 桑野 和善 中西 洋一

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.80, no.8, pp.571-575, 2005-08-15

被引用文献数

10

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症例は74歳女性。平成15年3月から10月まで当院総合診療部にて非結核性抗酸菌症(以下NTM症と略す。分離菌は<I>Mycobacteriumintreceltulare</I>)の加療が行われた。平成16年5月より喀痰・咳嗽が増悪し,NTM症の再燃と診断され6月14日に呼吸器科入院となった。胸部CTではぴまん性粒状影の増加と右肺に空洞・気胸・胸水の出現を認めた。喀痰にてガフキー陽性(集菌法にて3+),PCR法にて<I>M.intracellulare</I>陽性,また,胸水ADAが147IU/Lと高値であった。胸水から<I>M.intracellulare</I>は検出されなかったが,喀痰や胸水の検査から他の感染症を示唆する結果が得られなかったのでNTM症に対する加療を開始した。気胸,胸水は治療に伴い消失したことより気胸と胸膜炎はNTM症に合併したものと考えた。NTM症に胸膜炎が合併するのは稀であり, さらに気胸が合併したという報告はきわめて稀であり貴重な症例と考えられた。

著者

神宮 浩之 豊田 恵美子 小林 信之 工藤 宏一郎

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.79, no.6, pp.397-400, 2004-06-15

被引用文献数

6

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膜炎を合併した非結核性抗酸菌症の報告は稀であり, 今回私たちは胸水貯留を認めた肺M.kansasii症の1例を経験したので報告する。症例は60歳男性。数ヵ月前より続く全身倦怠感, 右肩凝り, 発熱を主訴に近医受診。胸部X線上, 右上葉の浸潤影を指摘され, 肺炎の診断で一般抗生剤の投与を受けるも改善せず, 肺結核疑いで平成15年5月7日当科入院となった。入院時, 右胸水を認め, 胸腔穿刺を行ったところ滲出性胸水でAdenosinedeaminase(IADA) は66.1U/lと高値を示した。また, ツベルクリン反応が強陽性であったことより肺結核を疑い, 気管支鏡検査を施行した。右B1aおよびB2aより行った経気管支肺生検では, 類上皮細胞肉芽腫病変を認め, 気管内吸引痰, 気管支擦過浮遊液, 気管支洗浄液のいずれの検体からも培養検査で <I>M.kansasii</I> が検出された。国立療養所非定型抗酸菌症共同研究班の診断基準より肺 <I>M.kansasii</I> 症と診断し, RFPを含む3剤の治療を行った。以後, 胸水再貯留は認めず, 全身状態良好で6月6日退院となった。

著者

佐々木 結花 山岸 文雄 八木 毅典 山谷 英樹 黒田 文伸 庄田 英明

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.77, no.6, pp.443-448, 2002-06-15

被引用文献数

3

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広汎空洞型肺結核 (<I>b</I>I3) 症例を臨床的に検討した。対象は95例, 平均年齢は49.5±13.0歳であった。結核発見動機は, 有症状受診84例, 他疾患管理中10例, 他疾患受診時偶然発見1例で, 全例が喀痰塗抹陽性であった。社会背景として職業は入院時無職31例, 日雇労務者24例, 生活保護受給者25例と, 社会的弱者が多数であった。入院時病状として重症例が多数であり栄養状態は不良であった。当院入院中に死亡した症例は19例 (20.0%) で全例男性であり, 結核発見動機は全例有症状受診で, 入院から死亡までの期間 (在院日数) は35.0±39.8日と短期であった。有症状受診例84例の受診の遅れの期間は5.5±5.0カ月であり診断の遅れの期間は0.3±0.9カ月と短期間であった。<I>b</I>I3症例は発見の遅れの長期化により重症化し, 受診の遅れがその大部分を占めた。予後不良であるこの病型が生じないために発見の遅れを短期化するよう多様な予防対策の実施が望まれる。

著者

岡崎 美樹 冨岡 洋海 長谷 川幹 片上 信之 坂本 廣子 石原 享介 岩崎 博信 梅田 文一 中井 準 岡田 行功 庄村 東洋

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.65, no.4, pp.293-297, 1990

被引用文献数

11

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A case of 22-year-old female with mediastinal tuberculous lymphadenitis and pericostal tuberculosis was reported.Her complaint was right chest pain and subcutaneous mass on the right chest wall.Chest contrast CT showed right paratracheal lymph node swelling with central low density area and surrounding rim enhancement, which has been reported as typical characteristics of mediastinal tuberculous lymphadenit is.Pigeon-egg sized subcutaneous mass with fluctuation was palpable on the right sternal border and the smear of its content showed acid-fast bacilli.In spite of two months therapy with antituberculous drugs, both masses were unchanged in size.The lesions resected surgically, were both encapsulated abscesses containing yellowish pus, and microscopic examination of these specimen disclosed the finding of tuberculosis.Mycobacterium tuberculosis was cultured from contents of both masses.After nine months of anti-tuberculous therapy, no sign of recurrence is observed until now.Both masses were discontinuous and the possibility of lymphangitic spread of organism was speculated as its etiology.

著者

重藤 えり子 佐藤 裕恵 重藤 紀和 鎌田 達 阿部 千代治 高橋 光良 森 亨

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.70, no.5, pp.347-354, 1995

被引用文献数

6

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A twenty-four year old male Peruvian of Japanese origin, who came to Japan in September 1990 and had been working in a minor factory in a rural area, was admitted to a hospital in March '91 with severe cough. Smear examination of his sputum smear was positive for acid-fast bacilli and his chest X-ray showed multiple cavities (Index case). Subsequent contact examination identified further four patients with pulmonary tuber culosis among his colleagues in the factory, all of whom lived in the same house with the index case.<BR>During following three years, further six patients with mycobacteriosis, two Peruvians and four Japanese, were found among the employee of that factory. M. tuberculosis was cultured from the sputa obtained from seven of these eleven patients. Another patient was diagnosed as non-tuberculous mycobacteriosis.<BR>Restriction fragment length polymorphism (RFLP) analysis carried out with five strains of M. tuberculosis isolated from these patients revealed the identical RFLP pattern which is uncommon in Japan. Still more, an isolate from another patient was subjected to RFLP analysis by chance, and was found to show the same RFLP pattern. Later epidemiological study revealed that the last patient, a 53 year-old saleswoman of boxlunch, might have some contact with the index case at her booth.<BR>Though RFLP analysis was not done for the isolate from the index case, from the identity of RFLP patterns of other isolates, clinical course and epidemiological study, it is considered that six patients were certainly, and two others were probably infected from the index case. One of the patients had a history of surgical treatment for pulmonary tuberculosis and, as RFLP analysis could not be carried out, it is not possible to determine whether his disease was due to reactivation or re-infection.<BR>Tuberculin skin test survey of 133 workers in the factory was carried out in March '91. The diameter of erythema showed bimodal distribution pattern for the Japanese workers. Considering that most of the young Japanese have been vaccinated with BCG, it is assumed that at least 40% (10/23) of Japanese workers younger than thirty years old were infected in this epidemic. All the Peruvians, who had not been vaccinated with BCG, showed positive reaction to PPD (mean diameter was 41.9mm) and were assumed to had been infected newly in this epidemics or in the past. Chemoprophylaxis were indicated for two young Peruvians only. Subsequent patients were diagnosed among the strong tuberculin reactors (For Japanese ≥50 mm, for Peruvians ≥30mm in diameter).<BR>Total delay in the diagnosis of the index case was considered to be about six months. Though he was coughing on his entrance to Japan on September '90, no reliable medical checkup was done until he was pointed out the abnormal findings on his chest X-ray image at a routine medical checkup in November '90. At that time he was recommended to go to some hospital or clinics, but he did not obey this recommendation promptly. Such a delay may cause this outbreak.

著者

藤木 明子

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.67, no.1, pp.19-26, 1992

被引用文献数

1

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Evaluation of sputum smear examination was carried out with smear slides stained by the Ziehl-Neelsen method, which were collected from Nepal, Yemen and the Philippines. The smear slides were checked macroscopically and microscopically according to the following points: 1) smear area size, 2) thickness of smear, 3) evenness of smear, 4) decolourizing condition by Ziehl-Neelsen stain, 5) smear cleanness, 6) presence of cells in sputum and 7) smear reading accuracy by cross-checking.<BR>As the result of smear slide evaluation, it was concluded that proper sputum specimens have been smeared but smears were generally too thin and contaminated with too many dirts.<BR>Agreement rate of the slide reading in Nepal, Yemen and the Philippines were 73%, 90% and 88% respectively. Disagreement cases were concentrated in the subtle number of acid fast bacilli or (±) and (+) results. The cause of disagreement might be attributed to contamination with debris, deposit etc., which hinderd reading or were misread as acid-fast bacilli.<BR>Some improvement should be considered to eliminate the dirts, such as filtration of carbol fuchsin solution, preparation of proper quantity of carbol fuchsin solution to be consumed within three months, mixing the fuchsin stock solution and 5% carbol solution just before use, rinsing the mouth before sputum collection, usage of clean sputum container and slides, and smearing and drying of the slides within clean environment.<BR>However, in many developing countries there are many difficulties for facilities, equipments, system and management. Some of these difficulties may be solved by the efforts of laboratory side but some are beyond the limits of their efforts. Under such circumstance, there should be limitation in keeping and maintaining the quality of the examination.<BR>When evaluation or quality check of smear examination is attempted, the quality must be defined taking such background conditions into consideration.

著者

星野 斉之 内村 和宏 山内 祐子

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.84, no.1, pp.1-8, 2009-01-15

被引用文献数

1

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〔目的〕青中年期結核罹患率の地域差を検討する。〔方法と結果〕2005年の結核発生動向調査と国勢調査を用いて,都道府県別の性・就業状況別の青中年期(25~54歳)罹患率を算出し,背景要因を検討した。〔結果〕都市と周辺地域の罹患率が高い。四大都市通勤圏とその他の地域の比較では,都市通勤圏の日本人の就業者,無職,主婦で有意に高かったが,主婦では差は小さかった。生活保護対象者の罹患率は高いが,受給率に地域差はなかった。外国人の罹患率は高いが,女性の無職・その他のみに地域差を認めた。電車・バス利用回数と罹患率が,就業者で強い相関を示したが,主婦に相関はなかった。居住状況と都道府県罹患率に相関はなかった。糖尿病,悪性腫瘍,関節リューマチの受療率は結核罹患率と相関せず,推定HIV感染合併患者数は少なく,除外しても罹患率の差異は保たれた。〔考察〕都市部における公共交通機関の利用と就業による感染リスクが示唆され,事業所の患者発見対策強化と必要時の公共交通機関における接触者健診が勧められる。また,貧困の影響の可能性があり,詳細な検討が必要である。外国人,居住状況,HIV感染,糖尿病,悪性腫瘍,関節リューマチの影響は示唆されない。

著者

近藤 有好

出版者

JAPANESE SOCIETY FOR TUBERCULOSIS

雑誌

結核 (ISSN:00229776)

巻号頁・発行日

vol.74, no.1, pp.33-41, 1999-01-15

被引用文献数

25

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Drug can cause various types of lung damages, with drug-induced pneumonitis (including acute interstitial pneumonia, usual interstitial pneumonia, desquamative interstitial pneumonia, nonspecific interstitial pneumonia, bronchiolitis obliterans with organizing pneumonia, eosinophilic pneumonia and hypersensitivity pneumonitis) being the most important among them. The incidence and the causative agents of drug induced pneumonitis have varied over time. Before 1980, anticancer agents and gold salts were the main drugs, and the number of causative drugs (61) and case reports was small. Recently, pneumonitis has increasingly been caused by Chinese herbal medicines, antibiotics, chemotherapy agents, anti-inflammatory drugs, analgesics, cytokines, and gold salts, and the number of case reports and drugs involved (177) has increased.<BR>Drug-induced pneumonitis has characteristics that depend on the causative agent. Review of our patients and reports in Japan revealed the following. Pneumonitis caused by anti-inflammatory drugs, analgesics, and antibiotics generally develops at 1-2 weeks after starting administration, and bronchoalveolar lavage and histologic examination of lung biopsies reveals the features of eosinophilic pneumonia. Such pneumonitis is associated with a high frequency of a positive drug lymphocyte stimulation test (DLST), and has a good outcome. Conversely, with pneumonitis caused by anticancer and immunosuppressive agents, the onset is often delayed and the disease has features of diffuse interstitial pneumonia and pulmonary fibrosis. The frequency of a positive DLST is low, and the outcome is generally poor. Pneumonitis induced by Chinese herbal medicines, gold salts, and antituberculosis agents has intermediate features between the above two types: i.e., it develops after 2-3 months or six months (gold salts), and resembles either eosinophilic pneumonia, BOOP or interstitial pneumonia.<BR>For <I>in vitro</I> identification of causative drugs, the DLST and the leukocyte migration inhibition test (LMIT) are generally used. The latter test is superior in sensitivity, suggesting that the mechanism of this test involves cytokines such as IL-1α, IL-1β, IL-2, TNF-α, and IL-8.