[Chemoprophylaxis for tuberculosis].
In Japan, a person who is 29 or younger, contacted a tuberculosis patient recently and judged to have received infection is the object of the chemoprophylaxis by the public expenditure. On the other hand, in ATS/CDC, they call chemoprophylaxis as the treatment of latent tuberculosis infection, and if there is a strong possibility that a person may appear tuberculosis, they start chemoprophylaxis, regardless of age. We usually prescribe isoniazid for latent tubercular infection. The period of prescription is at least 6 months, which is effective, but 9 months is more desirable. Recently, in the West, tuberculosis are frequent among patients who are administered Infliximab, anti-tumor necrosis factor-alpha. In Japan, after 6 months' evaluation period for Infliximab medication to rheumatoid arthritis, 11 out of 2,000 became tuberculosis (100,000 to 550). As for the tuberculin reaction before Infliximab medication, 2 were un-carrying out and 4 were negative. Moreover, even in positive examples, many of them were small redness. From this result, the Japanese Society for Tuberculosis and the Japan College of Rheumatology advised jointly. Those who are using immunosuppressant drugs and a doctor judged that they need chemoprophylaxis are supposed to the start medication if they are positive in tuberculin reaction, or there are some proof of tubercular infection on chest X-ray film, or there are high possibility of having received tubercular infection. By carrying out active chemoprophylaxis regardless of age, tuberculosis from high risk group is expected to decrease.
Yamagishi
Fumio
F
Department of Respiratory Diseases, National Hospital Organization Chiba-East National Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712, Japan. yamagisf@chibae.hosp.go.jp
D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D000069285:Infliximab; D007538:Isoniazid / Q000008:administration & dosage*; D007564:Japan; D008875:Middle Aged; D012306:Risk; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D007538:Isoniazid