結核の接触者健康診断の手引き(改訂第4版)
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- ともみ このえ
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6 elimination 2005 CDCCenters for Disease Control and Prevention NTCA National Tuberculosis Controllers Association 1998 CDHS CTCA Joint Guidelines EBM Evidence-Based Medicine 1
7 latent tuberculosis infection LTBI
8 contact investigation medical examination
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10 TBCTA Tuberculosis Coalition for Technical Assistance) 5
11 X 6
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14 Index Case Contact High-risk contact BCG HIV Close contact CDCNTCA WHO
15 Casual contact Non-contact Period of Infectiousness CDC
16 QFT BCG BCG Interferon-gamma release assays IGRAs (R) TB2GCellestis QFT-2G QFT-2G BCG QFT QFT QFT-3G 11
17 QuantiFERON TB Gold In-Tube 2009 (R) TB QFT-3G QFT-2G 12 QFT-2G 2010 QFT-3G QFT-2 QFT-3G QFT QFT QFT QFT QFT BCG 30 QFT QFT QFT QFT 50 QFT QFT 12 QFT QFT QFT QFT 50 QFT 12
18 QFT QFT QFT CDC QFT 17 QFT 14 QFT QFT IGRAs QFT QFT QFT QFT QFT QFT QFT BCG QFT QFT QFT 13
19 QFT QFT 10mm 5mm 16 20mm 10mm QFT QFT 10mm 5mm QFT window period QFT QFT 23 QFT (R)TB-2G QFT QFT 15 QFT QFT QFT-3G QFT 14
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21 N95 X 16
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25 BCG HIV 20
26 BCG 21
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28 BCG 23
29 WHO 24
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31 C 26
32 C C A C C A A 27
33 BCG QFT QFT QFT BCG QFT 50 QFT QFT QFT QFT 18 QFT QFT 1217 QFT QFT QFT QFT QFT QFT 8 28
34 QFT 812 QFT QFT QFT 17 QFT QFT QFT QFT QFT 812 QFT QFT 12 1 QFT QFT QFT QFT QFT 15% QFT 29
35 QFT QFT X QFT QFT QFT QFT QFT QFT QFT QFT HIV QFT QFT QFT QFT QFT QFT 1 QFT QFT QFT 30
36 QFT BCG BCG BCG BCG 14 BCG 30mm 10BCG BCG 30mm
37 BCG 30mmQFT QFT BCG BCG QFT QFT QFT QFT LTBI QFT BCG QFT 32
38 33 LTBI LTBI LTBI LTBI
39 QFT QFT QFT X LTBI 34
40 QFT LTBI QFT INH INH INH INH INH 6 3 INH INH RFP DOTS LTBI BCG HIV 35
41 QFT INH BCG INH INH BCG BCG INH 0.2g/ml RFP 4 6 INH RFP INH RFP PZAEB PZA 612 ATS/CDC mg/ ATS/CDC
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44 QFT QFT 39
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46 20 fingerprinting analysis 15 41
47 QFT RFLP VNTR DNA
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52 CDC: Guidelines for the investigation of contacts of persons with infectious tuberculosis; recommendations from the National Tuberculosis Controllers Association and CDC, United States. MMWR 54(RR-15), California Department of Health Services Tuberculosis Control Branch; California Tuberculosis Controllers Association: Contact investigation guidelines. Berkeley, CA: California Department of Health Services; p Tuberculosis Coalition for Technical Assistance. International Standards for Tuberculosis Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance, Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 167:723 5; CDC: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, MMWR 54(No. RR-17): 42, Madhi F, Fuhrman C, Monnet I, et al. Transmission of tuberculosis from adults to children in a Paris suburb. Pediatr Pulmonol 34:159 63; CDC: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, MMWR 54(No. RR-17): 5-6, , WHO: Tuberculosis and air travel : guidelines for prevention and control. 3rd ed, Geneva, Switzerland: WHO; Mori T, Harada N, Higuchi K, et al.: Waning of the specific interferon-gamma response after years of tuberculosis infection. Int J Tuberc Lung Dis. 11:1021-5; Mazurek GH, LoBue P, Iademarco MF, et al. : Guidelines for using the QuantiFERON(R)-TB Gold Test for detecting Mycobacterium tuberculosis infection, United States. MMWR. 54 (RR15): 49-55; TB-2G 815: QFT 85(1): QuantiFERON -TB 47
53 TB-2G Abubakar I: Tuberculosis and air travel: a systematic review and analysis of policy, Lancet Infect Dis. 10(3): , (1) Chiba Y: Significance of endogenous reactivation, 30 years follow-up of tuberculin positive converters, Bull IUAT, 49: , Sutherland I: The ten-year incidence of clinical tuberculosis following conversion in 2,550 individuals aged 14 to 19 years. TSRU Progress Report 1968 (KNCV, The Hague, The Netherlands) 22ATS/CDC: Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 161:S221 S247; Iseman MA: A Clinician's Guide to Tuberculosis. Lippincott Williams and Wilkins, ; The National Collaborating Centre for Chronic Conditions: Tuberculosis, Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Royal College of Physicians, London: Controlling Tuberculosis in the United StatesRecommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 54 (RR-12),
54 LTBI
55 表 13 ( 参考様式 ) 都道府県 ( 市 ) 名 結核集団感染発生事例について 1. 事例について (1) 集団感染と判明した時期 ( 集団感染の定義を満たすと判明した時期 ) 平成年月 (2) 集団感染の発生場所 2. 初発患者について (1) 性別, 年齢 男 女 ( 歳 ) (2) 職業 (3) 発症日 ( 推定 ) (4) 発症後最初に受診した医療機関の初診日 (5) 医療機関で結核と診断された日 (6) 保健所で結核の届出を受理した日 (7) 患者発見方法 ( 発見契機 ) (8) 喀痰検査 ( 塗抹等 ) の結果 (9) 胸部 X 線検査結果 ( 結核病学会分類 ) 平成 年 月 日 平成 年 月 日 平成 年 月 日 平成 年 月 日 3. 接触者健康診断について (1) 保健所方針決定日 (2) 接触者健康診断の開始日 平成平成 年年 月月 日日 (3) 対策の継続 終了の確認 A. 対策を継続中 ( 平成 年 月現在 ) B. 対策を終了 ( 平成 年 月 日 ) (4) 接触者健康診断 ( 集団感染対策 ) の実施成績受診結果 ( 精査結果を含む ) の内訳全対象者数受診者数区分結核患者 LTBI その他異常 (A)+(B) (A) ( 確定例 ) ( ) なし患者家族 未受診者数 (B) 家族以外合計 ( )LTBI: 潜在性結核感染症 と診断され結核医療( 従来の化学予防 ) の対象とされた者 4. その他 ( 本事例において気付いた問題点など )
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Kekkaku Vol. 79, No. 1: 17-24, 2004 17 (Received 21 Aug. 2003/Accepted 18 Nov. 2003) Fig. 1 Trends of TB incidence rates for all forms and smear-positive pulmonary TB in Kawasaki City and Japan. Incidence=newly
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2017 年 8 月 9 日放送 結核診療における QFT-3G と T-SPOT 日本赤十字社長崎原爆諫早病院副院長福島喜代康はじめに 2015 年の本邦の新登録結核患者は 18,820 人で 前年より 1,335 人減少しました 新登録結核患者数も人口 10 万対 14.4 と減少傾向にあります
2017 年 8 月 9 日放送 結核診療における QFT-3G と T-SPOT 日本赤十字社長崎原爆諫早病院副院長福島喜代康はじめに 2015 年の本邦の新登録結核患者は 18,820 人で 前年より 1,335 人減少しました 新登録結核患者数も人口 10 万対 14.4 と減少傾向にありますが 本邦の結核では高齢者結核が多いのが特徴です 結核診療における主な検査法を示します ( 図 1) 従来の細菌学的な抗酸菌の塗抹
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て 弥生時代に起こったとされています 結核は通常の肺炎とは異なり 細胞内寄生に基づく免疫反応による慢性肉芽腫性炎症であり 重篤な病変では中が腐って空洞を形成します 結核は はしかや水疱瘡と同様の空気感染をします 肺内に吸いこまれた結核菌は 肺胞マクロファージに貪食され 細胞内で増殖します 貪食された
2014 年 7 月 2 日放送 潜在性結核感染症 (LTBI) について 日本赤十字社長崎原爆諫早病院 福島 副院長 喜代康 結核菌の歴史まずはじめに 結核という病気についてお話しします 結核は過去の病気だと思われている人も多いと思いますが 日本では 2012 年に年間約 2 万 1,000 人の方が新たに発病し 約 2,000 人が亡くなっておられます また 世界の人口の約 1/3 が結核の感染を受けており
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