Fukazawa K, Aritake S, Minemura S, Shinohara T, Nakazono T, Mori T
Tokyo Metropolitan Hachioji Public Health Center.
Nihon Koshu Eisei Zasshi. 2000 Sep;47(9):801-8.
We experienced a tuberculosis outbreak in a mental hospital and discussed preventive measures for nosocomial tuberculosis infection.
There are 18 mental hospitals within the administrative area of Hachioji public health center (PHC). A Total of 18 pulmonary tuberculosis cases were diagnosed in one of these hospitals between December 1995 and November 1998. They were all inpatients and two of them had history of tuberculosis. Fifty-two persons became candidates for isoniazid (INH) chemoprophylaxis as a consequence of the first extraordinary health examination. Chest radiographs of the inpatients had not been taken regularly in this hospital. Our recognition of the tuberculosis outbreak was delayed by omission of not only the case notification from the doctor who had diagnosed tuberculosis but the information from the PHC that had received the application of public subsidy for medical treatment. All cultured bacilli from 8 patients were susceptible to INH, rifampicin, streptomycin and ethambutol. Restriction fragment length polymorphism (RFLP) analysis of 4 strains, which we could have obtained, demonstrated an identical pattern.
To prevent tuberculosis outbreaks in mental hospitals, we should consider these problems as follows; 1) Physical conditions of inpatients should be observed carefully and suitable physical checkups on inpatients with tuberculosis symptoms should be carried out by mental hospitals. 2) The doctor who had diagnosed a patient as having tuberculosis must send the case notification to the nearest PHC. 3) The PHC that received the information should investigate the case carefully and notify all related PHC's. 4) Extraordinary health examinations should be done appropriately by leadership of the PHC. 5) RFLP analysis of the tubercle bacilli is very useful to probe the source and route of infection. 6) Criteria for chemoprophylaxis for more than middle-aged persons should be established.
我们经历了一家精神病院内的结核病暴发，并讨论了医院内结核病感染的预防措施。
八王子公共卫生中心（PHC）辖区内有18家精神病院。1995年12月至1998年11月期间，其中一家医院共诊断出18例肺结核病例。他们均为住院患者，其中两人有结核病病史。首次非常规健康检查后，52人成为异烟肼（INH）化学预防的对象。该医院未定期为住院患者进行胸部X光检查。我们对结核病暴发的认识因以下原因而延迟：不仅诊断出结核病的医生未上报病例，而且接受医疗公共补贴申请的PHC也未提供相关信息。8名患者的所有培养菌株对INH、利福平、链霉素和乙胺丁醇均敏感。我们获得的4株菌株的限制性片段长度多态性（RFLP）分析显示出相同的模式。
为预防精神病院内的结核病暴发，我们应考虑以下问题：1）应仔细观察住院患者的身体状况，精神病院应对有结核病症状的住院患者进行适当的身体检查。2）诊断患者患有结核病的医生必须将病例上报给最近的PHC。3）收到信息的PHC应仔细调查该病例，并通知所有相关的PHC。4）PHC应在其领导下适当进行非常规健康检查。5）结核杆菌的RFLP分析对于查明感染源和传播途径非常有用。6）应制定针对中年以上人群化学预防的标准。
