Hattori Toshio, Kobayashi Nobuyuki, Nagai Hideaki, Chagan-Yasutan Haorile, Telan Elizabeth, Solante Marietta B
Graduate School of Health Science, KIBI International University, Japan.
Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital, Japan.
Int J Mycobacteriol. 2016 Dec;5 Suppl 1:S18-S19. doi: 10.1016/j.ijmyco.2016.09.009. Epub 2016 Oct 22.
Although the prevalence of pulmonary tuberculosis (TB) and HIV infection in Japan is low, careful monitoring of these two diseases is necessary. We conducted a nationwide survey on multidrug resistant (MDR)-TB (2011-2013) and HIV-TB (2007-2014) to understand the mode of prevention and the effect of therapy. A study on MDR-TB and HIV in San Lazaro Hospital (SLH) in the Philippines was also conducted. These studies introduced an international collaborative study against the global epidemics of HIV-TB/MDR-TB.
The nationwide survey of MDR-TB was done in hospitals that treat TB patients in Japan from 2011 to 2013. The HIV-TB survey has been done every year since 2007. Classic information such as chest X-ray (CXR) as well as computed tomography (CT) results for each patient were analyzed. Likewise, the presence of a cavity, involved segments, and patterns of parenchymal lesion were assessed. Finally, tentative diagnosis and disease activity, bronchogenic spread of the lesion with CT, and bronchiectasis were recorded. At SLH, sputa of suspected cases were subjected to GeneXpert testing and HIV testing was performed on all TB patients.
In the nationwide MDR survey in Japan, 171 patients were diagnosed as pulmonary MDR-TB (0.2% of total Mycobacterium tuberculosis (MTB) in Japan). Among them, 48 (28%) were foreigners and most were living in big cities. In Tokyo metropolitan areas, 27 out of 53 MDR-TB patients were foreigners: 13 were from China, 4 from the Philippines, and 3 from Myanmar. Thirty nine among 53 MDR-TB patients were cured or treatment was completed with favorable prognosis. Five deaths (9.4%) and six departures from Japan (11.3%) were noted. In the HIV-TB survey in National Hospitals, the HIV-positive rates on MTB were constantly low (0.23-0.46%) from 2007 to 2014. Among the reported 114 HIV-TB patients (0.37% of total MTB in National Hospitals), 17 were foreigners and 3 (2.6%) were MDR-TB cases (2 Chinese, 1 Japanese). Half of the HIV-TB patients have low CD4 cell numbers (<100/μL). Two out of the 3 MDR-TB patients were cured. Imme reconsitution inflammatory syndrome (IRIS) was found in 48% of all HIV-TB cases. At SLH in the Philippines, total numbers of GeneXpert examined cases were 1052 cases in 2015, and 122 Rifampicin resistant (RR)-TB cases (11.6%) were found and among the enrolled 96 cases 14 (15%) were found to be HIV positive.
Very low numbers of TB or HIV patients have been observed in Japan. An increasing number of foreign-born MDR-TB patients in the country was found. To combat against these global epidemics, an international collaboration against HIV-TB/MDR-TB is needed.
尽管日本肺结核（TB）和HIV感染的患病率较低，但仍有必要对这两种疾病进行密切监测。我们开展了一项全国性的耐多药（MDR）-TB（2011 - 2013年）和HIV-TB（2007 - 2014年）调查，以了解预防模式和治疗效果。同时还在菲律宾的圣拉萨罗医院（SLH）开展了一项关于MDR-TB和HIV的研究。这些研究引入了一项针对HIV-TB/MDR-TB全球流行的国际合作研究。
2011年至2013年在日本治疗TB患者的医院开展了全国性的MDR-TB调查。自2007年起每年进行HIV-TB调查。分析了每位患者的胸部X线（CXR）以及计算机断层扫描（CT）结果等经典信息。同样，评估了空洞的存在、受累节段以及实质病变的模式。最后，记录了初步诊断和疾病活动情况、CT显示的病变支气管播散以及支气管扩张情况。在SLH，对疑似病例的痰液进行GeneXpert检测，并对所有TB患者进行HIV检测。
在日本的全国性MDR调查中，171例患者被诊断为肺部MDR-TB（占日本结核分枝杆菌（MTB）总数的0.2%）。其中，48例（28%）为外国人，大多数居住在大城市。在东京都市区，53例MDR-TB患者中有27例为外国人：13例来自中国，4例来自菲律宾，3例来自缅甸。53例MDR-TB患者中有39例治愈或完成治疗，预后良好。记录到5例死亡（9.4%）和6例离开日本（11.3%）。在国立医院的HIV-TB调查中，2007年至2014年MTB的HIV阳性率一直较低（0.23 - 0.46%）。在报告的114例HIV-TB患者中（占国立医院MTB总数的0.37%），17例为外国人，3例（2.6%）为MDR-TB病例（2例中国人，1例日本人）。一半的HIV-TB患者CD4细胞数较低（<100/μL）。3例MDR-TB患者中有2例治愈。在所有HIV-TB病例中，48%发现有免疫重建炎症综合征（IRIS）。在菲律宾的SLH，2015年GeneXpert检测的病例总数为1052例，发现122例利福平耐药（RR）-TB病例（11.6%），在纳入的96例病例中，14例（15%）被发现HIV阳性。
在日本观察到的TB或HIV患者数量非常少。该国出生的外国MDR-TB患者数量在增加。为应对这些全球流行疾病，需要开展针对HIV-TB/MDR-TB的国际合作。
