It became clear by questionnaires that many medical dialysis did not know about the recommendation of treatment for latent tuberculosis infection from the Japanese Society for Tuberculosis.
Kekkaku Vol.85, No.1:47-60, 2010
The 84th Annual Meeting Mini-Symposium
PREVENTION OF TUBERCULOSIS IN MEDICALLY HIGH-RISKED PATIENTS
Chairpersons : 1Yuka SASAKI and 2Emiko TOYOTA
Abstract
In the last ten years, prevalence rate of tuberculosis have been successfully decreasing under 20/100,000 in Japan and great advance has been brought about in this field ;for instance IGRAs (QFT etc) and diagnosis of LTBI.
The Japanese Society for Tuberculosis declared statement to perform more active prophylaxis in 2004 but we have still many of compromised patients with TB who could be prevented from getting active tuberculosis.
With this symposium, we discussed how to work up actually on this problem in each clinical sites. We should alert physicians participating with medically high-risk patients to recognize the risk of tuberculosis and to promote prevention. In addition, treatment of LTBI should be registered to Public Health Center.
1. A study how to prevent the appearance of active tuberculosis in patients with corticosteroids : Is the state of implementation of medication for LTBI proper?: Masahiro KAWASHIMA (National Hospital Organization Tokyo National Hospital)
The statement for treatment of LTBI by the Japanese Society for Tuberculosis in 2004 gives a concrete description about treatment of LTBI in patients with corticosteroids, but the state of implementation of medication for LTBI in patients with corticosteroids is unclear.
41 cases with active tuberculosis occurred during steroids therapy were studied and at least 15 cases were thought to have been indicative of LTBI retrospectively.
Evaluation of risk for TB before and during steroids therapy were insufficient and medication for LTBI were unpracticed.
On the other hand, 61 cases who started steroids therapy in our hospital were studied.
Examination of sputum, chest-CT scanning, QFT or PPD were performed in most of all patients and then 17 cases were thought to be indication of treatment of LTBI but actually only followed.
One patients progressed active TB. Promotion of treatment of LTBI for patients with corticosteroids may leads the decrease of active tuberculosis in those patients.
2. Tuberculosis among patients with rheumatoid arthritis ; steroids to anti-TNF: Tomoshige MATSUMOTO (Osaka Prefectural Medical Center for Respiratory and Allergic Diseases)
Anti-TNF agents made rheumatoid arthritis remittent effectively but occurrence of TB disease increase as more use of them.
We already reported some of problems as follows:
1) diagnosis of LTBI,
2) method and duration for treatment for LTBI not sufficiently established,
3) difficult diagnosis of TB because of atypical figures,
4) paradoxical response,
5) to stop anti-TNF agents make control of RA difficult for rebound,
6) not established treatment for RA after TB treatment,
7) less professional institutions to treat both RA and TB.
Data of over 5000 cases who were treated by Remicade revealed TB did not occur among cases with INH prophylaxis.
Furthermore there are possible use of anti-TNF agent with antituberculous agents.
Then it is recommended that screening for TB is necessary before starting anti-TNF agent and prophylaxis by INH if possible LTBI.
We should be careful not to misdiagnose worsening RA by sign of TB or other infectious diseases.
3. A consideration of the prevention from tuberculosis in hemodialysis patients: Takeshi KAWASAKI (National Hospital Organization Chiba-East National Hospital)
Hemodialysis patients have been increasing and aging in Japan, and they are in great danger of tuberculosis.
When hemodialysis patients become tuberculosis, there is a possibility of infection to other patients, so the prevention, early detection and treatment for tuberculosis are very important.
It became clear by questionnaires that many medical dialysis did not know about the recommendation of treatment for latent tuberculosis infection from the Japanese Society for Tuberculosis.
It is important to examine and treat actively for latent tuberculosis infection of hemodialysis patients for the pre vention of tuberculosis, and needed to enlighten to medical dialysis.
4. Prevention of active tuberculosis in HIV-infected persons: Akira FUJITA Tokyo Metropolitan Fuchu Hospital
The risk for active TB among HIV-infected persons is about from 20 to 200 times higher than among the general population.
In Japan which is one of TB middle-burden countries and has BCG vaccination program, interferon-gamma release assay (IGRA) is useful rather than tuberculin skin test for the diagnosis of latent TB infection (LTBI).
IGRA for the diagnosis of LTBI is recommended for HIV-infected persons with CD4 positive lymphocyte (CD4 counts above 50 cells/mm3, because our study suggested the sensitivity of QFT-G in the patients with CD4 counts below 50 cells/mm3 may be low). Appropriate TB contact investigation for HIV-infected persons is important.
For example, contacts who do not know their HIV infection status should be advised to take HIV testing in the urban areas with high HIV prevalence rate.
A possible correlation between non-adherence to highly active antiretroviral therapy and the risk of active TB development suggests that good adhere to antiretroviral drugs will be able to prevent active TB in HIV-infected patients.
5. Administration’s problems for latent tuberculosis infection (LTBI): Chika SHRAI (Public Health Center of Kobe City)
Clinician is obliged to report medication-required LTBI to Public Health Center, based on the Infectious Diseases Control Law.
The Administration is unable to assess measures for TB without these reports.
It is mandatory to own significance of LTBI reports and high-risk factors jointly by clinicians and public health facilities.
It ought to acknowledge these procedures as essential tactics to eliminate TB through low spread.
