Yamagishi Fumio, Toyota Makoto
National Hospital Organization Chiba-East National Hospital.
Kekkaku. 2009 Dec;84(12):767-8.
With this symposium, we focused on the relapse of tuberculosis in Japan. Out of 19,893 tuberculosis patients registered in 2007 in Japan, 7.48% were classified as relapse cases. Relapse cases have the risk of acquired drug resistance. But we have few analyses of the proportion of relapse tuberculosis cases with standard short course regimens for six months, factors contributing to tuberculosis relapse and the proportion of drug resistance among relapse TB cases in Japan. Therefore we analyzed the relapse tuberculosis cases in two rural areas and three urban areas. We also analyzed the proportion of drug resistance among relapse cases with the data of drug susceptibility survey of Ryoken. 1. Research of relapse tuberculosis cases: Makoto TOYOTA (Kochi City Public Health Center). To clarify the relapse rate and factors contributing to tuberculosis relapse, we investigated the relapse tuberculosis cases in the municipality where the proportion of elderly tuberculosis patients was high. Out of 902 tuberculosis patients registered in Kochi City Public Health Center during 10 years, 20 pulmonary tuberculosis patients were confirmed relapse cases with initial registered records. Pretreatment cavitations, sputum culture positivity at 2 months, medical miss-management (e.g. number of doses, duration of therapy) and poor adherence were considered to be factors contributing to tuberculosis relapse. Out of 20 relapse cases, 12 cases were detected with symptoms, while only 3 cases were detected by examination in law. 2. A clinical study on relapse cases of pulmonary tuberculosis: Shuichi TAKIKAWA (National Hospital Organization Nishibeppu National Hospital). The relapse of pulmonary tuberculosis was investigated. In the cases with a treatment history before short course chemotherapy, drug resistance rate was high, and thus it needs to be cautious of drug resistance at the time of the retreatment. In the cases with a treatment history of short course chemotherapy, relapse cases were recognized more significantly in male cases aged 70's. In the cases that deviated from the standard treatment and that became impossible to use rifampicin, it should be careful to emergence of isoniazid resistance. 3. The current status of the recurrence tuberculosis cases in Tokyo: Michiko NAGAMINE (Specific Disease Control Section, Tokyo Metropolitan Government Bureau of Social Welfare and Public Health). As for the background of the patient whose disease has relapsed, unstable elements are observed. After any symptom, more patients are diagnosed as a relapse case rather than finding by a medical check up. And more than half are related to homeless or life without fixed address. Their status of insurance is the livelihood protection, no insurance or the national health insurance. By RFLP analysis in Shinjuku city, some clusters have recurrent cases, one of clusters has both a relapse and exogenous reinfection. This is able to elucidate an infectious state. Like this, the analysis of each cluster can help effective countermeasures. 4. Recurrence of tuberculosis in the City of Yokohama between 2004 and 2008: Michihiko YOSHIDA (Shinagawa Public Health Center), Takahiro TOYOZAWA (Yokohama Public Health Center). To identify the TB recurrence rate, we studied a cohort of 40 cases (treatment completion 36 cases, interruption 4 cases) of whom had a previous history of TB treatment including isoniazid and rifampicin. The time for relapse was 7.9 +/- 8.6 years and the overall relapse rate was 0.6% (0.47-0.7%). Our study suggested the relapse was almost equal to the low incident countries but the long-term follow-up and surveillance data should be carefully evaluated. 5. Comparison of the retreatment cases of pulmonary tuberculosis: Yuka SASAKI (National Hospital Organization Chiba-East National Hospital). To investigate the factors of the retreatment of pulmonary tuberculosis, 134 retreatment cases were studied. The factors leading to retreatment were cavitary and large lesions in chest X-p, sputum smear positive and heavy alcohol-drinkers. The factors leading to defaulting of the treatment were lack in understanding of the treatment and their economic problems. Reexamination of the treatment and support of the patients are important to prevent the retreatment of the pulmonary tuberculosis. 6. Proportion of drug resistance among relapse tuberculosis cases, summary of Ryoken studies 1977-2002: Takashi YOSHIYAMA (Fukujuji Hospital).
We have no historical analysis of the proportion of drug resistance among relapse TB cases. Therefore we would like to analyze the proportion of drug resistance among relapse cases in Japan.
Re-analysis of the data of drug susceptibility survey of Ryoken from 1977 to 2002.
The proportion of relapse cases among Ryoken has decreased in 1982-1987 and that proportion was 10% in 2002. The average age of relapse cases was 5 years older than the new cases and it was 66 years in 2002. The proportion of drug resistance among relapse cases has decreased form 39% (in 1977) to 16% (in 2002) for isoniazid, was stable and around 10% for rifampicin with 7.5% in 2002. The risk factors for drug resistance were younger age, foreigners and part time job. The proportion of drug resistance was higher among cases that were failure with previous treatment, then default with previous treatment and lower among cases with cure/completion at the previous treatment but this tendency was without significance.
在本次研讨会上,我们聚焦于日本结核病的复发情况。在2007年日本登记的19893例结核病患者中,7.48%被归类为复发病例。复发病例存在获得性耐药的风险。但我们对采用标准六个月短程治疗方案的复发结核病病例比例、导致结核病复发的因素以及日本复发结核病病例中的耐药比例分析较少。因此,我们分析了两个农村地区和三个城市地区的复发结核病病例。我们还利用“疗健”药物敏感性调查的数据,分析了复发病例中的耐药比例。1. 复发结核病病例研究:丰田诚(高知市公共卫生中心)。为明确复发率及导致结核病复发的因素,我们对老年结核病患者比例较高的市的复发结核病病例进行了调查。在高知市公共卫生中心10年间登记的902例结核病患者中,有20例肺结核患者经初始登记记录确诊为复发病例。治疗前有空洞形成、治疗2个月时痰培养阳性、医疗管理失误(如服药剂量、治疗疗程)以及依从性差被认为是导致结核病复发的因素。在20例复发病例中,12例是有症状时被发现,而通过法定检查发现的仅有3例。2. 肺结核复发病例的临床研究:泷川修一(国立医院组织西别府国立医院)。对肺结核复发情况进行了调查。在有短程化疗前治疗史的病例中,耐药率较高,因此在再次治疗时需谨慎对待耐药问题。在有短程化疗治疗史的病例中,70多岁男性病例的复发情况更为明显。在偏离标准治疗且无法使用利福平的病例中,应注意异烟肼耐药的出现。3. 东京复发结核病病例的现状:长岭美智子(东京都社会福祉和公共卫生局特定疾病控制科)。对于疾病复发患者的背景,存在不稳定因素。在出现任何症状后,被诊断为复发病例的患者多于通过体检发现的患者。并且超过半数与无家可归或无固定住址的生活有关。他们的保险状况是生活保障、无保险或国民健康保险。通过在新宿市的限制性片段长度多态性分析,一些集群存在复发病例,其中一个集群既有复发又有外源性再感染。这有助于阐明感染状态。像这样,对每个集群的分析有助于采取有效的应对措施。4. 2004年至2008年横滨市结核病的复发情况:吉田道彦(品川公共卫生中心)、丰泽隆博(横滨公共卫生中心)。为确定结核病复发率,我们研究了一组40例(完成治疗36例,中断治疗4例)有包括异烟肼和利福平在内的既往结核病治疗史的病例。复发时间为7.9±8.6年,总体复发率为0.6%(0.47 - 0.7%)。我们的研究表明复发情况几乎与低发病率国家相当,但长期随访和监测数据应仔细评估。5. 肺结核复治病例的比较:佐佐木由香(国立医院组织千叶东部国立医院)。为调查肺结核复治的因素,研究了134例复治病例。导致复治的因素是胸部X线有空洞和大病灶、痰涂片阳性以及重度饮酒者。导致治疗中断的因素是对治疗缺乏了解以及经济问题。重新审视治疗并为患者提供支持对于预防肺结核复治很重要。6. 复发结核病病例中的耐药比例,1977 - 2002年“疗健”研究总结:吉山隆(福住寺医院)。
我们没有对复发结核病病例中的耐药比例进行历史分析。因此,我们希望分析日本复发病例中的耐药比例。
对1977年至2002年“疗健”药物敏感性调查的数据进行重新分析。
“疗健”中复发病例的比例在1982 - 1987年有所下降,2002年该比例为10%。复发病例的平均年龄比新发病例大5岁,2002年为66岁。复发病例中异烟肼的耐药比例从1977年的39%降至2002年的16%,利福平的耐药比例稳定在10%左右,2002年为7.5%。耐药的危险因素是年龄较小、外国人以及兼职工作。在既往治疗失败的病例中耐药比例较高,其次是既往治疗中断的病例,而既往治疗治愈/完成的病例中耐药比例较低,但这种趋势无统计学意义。