Kekkaku. 2010 Feb;85(2):139-42.
Regarding current case findings, the mode of detection, delays in detection, the patient's occupation and so on were observed using the tuberculosis (TB) surveillance database. 81.3% of 24,760 TB patients newly notified in 2008 were detected at medical institutions. However, 10.8% of TB patients were detected during hospitalization with a disease other than TB and 8.5% of TB patients were detected under outpatients with a disease other than TB. The proportion of TB patients detected during inpatient or outpatient increased with age. On the other hand, significant proportion of adolescents and young adults were also detected by active case finding such as periodic school mass-screening and periodic health examination for employees. 22.5% of TB patients aged 15-19 years were detected by periodic school mass-screening, and 24.9% of TB patients aged 25-34 years were detected by periodic health examination for employees. Although active case finding generally detects bacillary negative cases, 14.1% of sputum smear positive pulmonary TB patients aged 20-49 years were detected by periodic health examination for employees. Although the proportion of TB patients detected by contact examination was only 3.0%, they were large among younger TB patients, e.g. 53.7% of those aged 0-14 years, 19.4% of those aged 15-19 years, 9.2% of those aged 20-24 years and 6.7% of those aged 25-29 years. According to the symptoms of 19,393 pulmonary TB patients, 28.7% had respiratory symptoms, 30.4% had both respiratory and other symptoms, and 15.1% had symptoms other than respiratory symptom. 24.8% of pulmonary TB patients had no symptoms and 0.9% had no data about symptoms. The proportion of TB patients only having other symptoms without respiratory symptoms increased among the elderly TB patients, e.g. 13.7% of those aged 65-69 years, 16.2% of those aged 70-74 years, 18.0% of those aged 75-79 years, 19.7% of those aged 80-84 years, 22.1% of those aged 85-89 years and 26.5% of those aged 90 years and over. Regarding the delay of case detection among 14,400 symptomatic pulmonary TB patients, patient's delay was longer in those aged 20-64 years and shorter in those aged 65 years and over. While, doctor's delay showed an inverse relationship with patient's delay. Total delay combining patient's delay and doctor's delay was strongly influenced by patient's delay. The sputum smear positive symptomatic pulmonary TB patients showed much longer total delay, and the proportion of total delay exceeding 3 months was 27.5% in those aged 20-64 years. Regarding occupation, the proportion of service workers and nurses/public health nurses were large among young TB patients. 8.4% of male TB patients aged 20-24 years and 10.8% of female TB patients aged 20-24 years were service workers. 10.7% of female TB patients aged 25-49 years were nurses/public health nurses. TB control for nosocomial infection is still important in Japan.
关于当前病例的调查结果，利用结核病监测数据库观察了检测方式、检测延迟、患者职业等情况。2008年新报告的24760例结核病患者中，81.3%是在医疗机构被检测出的。然而，10.8%的结核病患者是在因其他疾病住院期间被检测出的，8.5%的结核病患者是在因其他疾病门诊就诊时被检测出的。住院或门诊期间被检测出的结核病患者比例随年龄增长而增加。另一方面，相当比例的青少年和年轻人也是通过主动病例发现，如学校定期集体筛查和员工定期健康检查被检测出的。15 - 19岁的结核病患者中有22.5%是通过学校定期集体筛查被检测出的，25 - 34岁的结核病患者中有24.9%是通过员工定期健康检查被检测出的。虽然主动病例发现一般检测出的是菌阴病例，但20 - 49岁的痰涂片阳性肺结核患者中有14.1%是通过员工定期健康检查被检测出的。虽然通过接触者检查检测出的结核病患者比例仅为3.0%，但在年轻结核病患者中占比很大，例如0 - 14岁的患者中占53.7%，15 - 19岁的患者中占19.4%，20 - 24岁的患者中占9.2%，25 - 29岁的患者中占6.7%。根据19393例肺结核患者的症状，28.7%有呼吸道症状，30.4%既有呼吸道症状又有其他症状，15.1%有呼吸道症状以外的其他症状。24.8%的肺结核患者没有症状，0.9%没有症状数据。仅出现呼吸道症状以外其他症状的结核病患者比例在老年结核病患者中有所增加，例如65 - 69岁的患者中占13.7%，70 - 74岁的患者中占16.2%，75 - 79岁的患者中占18.0%，80 - 84岁的患者中占19.7%，85 - 89岁的患者中占22.1%，90岁及以上的患者中占26.5%。关于14400例有症状的肺结核患者的病例检测延迟情况，20 - 64岁患者的患者延迟时间较长，65岁及以上患者的患者延迟时间较短。而医生延迟与患者延迟呈反比关系。患者延迟和医生延迟相结合的总延迟受患者延迟的影响很大。痰涂片阳性的有症状肺结核患者的总延迟时间长得多，20 - 64岁患者中总延迟超过3个月的比例为27.5%。关于职业，年轻结核病患者中服务业工人以及护士/公共卫生护士的比例较大。20 - 24岁的男性结核病患者中有8.4%是服务业工人，20 - 24岁的女性结核病患者中有10.8%是服务业工人。25 - 49岁的女性结核病患者中有10.7%是护士/公共卫生护士。在日本，医院感染的结核病防控仍然很重要。
