Andoh Katsuya, Yamanaka Katsumi, Akashi Tomi
Nagoya City Midori Health Center, 1-715, Aibaragou, Midori-ku, Nagoya-shi, Aichi 458-0033, Japan.
Kekkaku. 2002 Sep;77(9):589-95.
A high school teacher was diagnosed as pulmonary tuberculosis. He was 27 years old and taught bookkeeping to the 1st year grade students in classes 3 and 6, the 2nd year grade students in classes 4 and 5. He was also the assistant teacher in charge of class 1 of the 3rd year grade students and the adviser of the badminton club in the school. He first noticed a slight cough in November 1999, and visited his physician. On December 24, he visited again for a moderate cough, fever and chill and was administered medicine and drip infusion for a cold. In the middle of January 2000, he visited another physician for a severe cough. He was referred to hospital N and was admitted due to an abnormal shadow on chest X-ray films. The result of sputum smear examination was positive for AFB, Gaffky 8. Subsequent contacts examination was conducted for 153 students and 63 teachers of the school. A tuberculin skin test survey of 153 students was also carried out, in February 2000. The diameter of erythema revealed a monomodal distribution pattern in students, however, one student was diagnosed as pulmonary tuberculosis by the chest X-ray examination, and 27 (18%) showed erythema 40 mm and larger. They were indicated chemoprophylaxis as they were most likely newly infected in this epidemic. After 2 months, a second contact examination was conducted for the students (excluding those who underwent chemoprophylaxis or had tuberculosis) and all teachers. Based on chest X-ray examination, two new students and one teacher were diagnosed as pulmonary tuberculosis, and another one student was diagnosed as tuberculous pleurisy. Comparing the erythema size distribution in the first and second tuberculin tests, the distribution of the latter markedly shifted to right, namely became much larger than the former. It was assumed that students in whom the difference in erythema diameter was larger than 17 mm between the first and second examinations had been newly infected in this epidemic. Chemoprophylaxis was indicated for 45 students and 3 teachers. After 6 months, a third contact examination was conducted for the students and teachers (excluding those who underwent chemoprophylaxis or had tuberculosis). After a year, one teacher was diagnosed as pulmonary tuberculosis by the fourth contact examination (chest X-ray). Restriction fragment length polymorphism (RFLP) analysis was carried out with 2 strains of M. tuberculosis isolated from these patients (the index case and the second teacher patient), and the RFLP pattern of 2 patients was same.
一名高中教师被诊断为肺结核。他27岁，教授一年级3班和6班、二年级4班和5班的簿记课程。他还是三年级1班的助理班主任以及学校羽毛球俱乐部的指导老师。他于1999年11月首次注意到轻微咳嗽，并去看了医生。12月24日，他因咳嗽加重、发烧和寒战再次就诊，医生给他开了感冒药并进行了静脉输液。2000年1月中旬，他因剧烈咳嗽去看了另一位医生。他被转诊至N医院，因胸部X光片有异常阴影而入院。痰涂片检查结果显示抗酸杆菌阳性，加夫基8级。随后对该校153名学生和63名教师进行了接触者检查。2000年2月还对153名学生进行了结核菌素皮肤试验调查。学生中红斑直径呈单峰分布模式，然而，一名学生经胸部X光检查被诊断为肺结核，27名（18%）学生红斑直径达40毫米及以上。由于他们很可能是在此次疫情中 newly infected，所以被建议进行化学预防。2个月后，对学生（不包括接受化学预防或已患结核病的学生）和所有教师进行了第二次接触者检查。根据胸部X光检查，两名新学生和一名教师被诊断为肺结核，另一名学生被诊断为结核性胸膜炎。比较第一次和第二次结核菌素试验中红斑大小分布，后者的分布明显向右偏移，即比前者大得多。假定第一次和第二次检查中红斑直径差异大于17毫米的学生是在此次疫情中 newly infected。45名学生和3名教师被建议进行化学预防。6个月后，对学生和教师（不包括接受化学预防或已患结核病的人员）进行了第三次接触者检查。一年后，第四名接触者检查（胸部X光）时一名教师被诊断为肺结核。对从这些患者（首例病例和第二名教师患者）分离出的2株结核分枝杆菌进行了限制性片段长度多态性（RFLP）分析，两名患者的RFLP模式相同。
