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Tuberculosis - An Old Disease with a New FaceTuberculosis glossary of terms

A

Airborne infection (Droplet nuclei infection)

This type of infection happens when the liquid part of a cough or sneeze containing viruses or bacteria evaporates, scatters as small particles, and remains floating in the air until someone breathes it in. Depending on how the air containing the droplet nuclei moves, such an infection may spread across a wide area.

B

BCG vaccine

The BCG is a vaccine that uses a weakened strain of the TB bacterium. When the vaccine is administered to someone who has never been infected with TB, it produces a very light TB reaction in the skin to create immunity. People who receive the vaccine are only 1/5 as likely to get TB than people who are not vaccinated. The vaccine remains effective for 10-15 years.
According to the Preventive Vaccination Act, (Japan), babies must be vaccinated by the time they reach 1 year old. (The vaccination is usually administered when the baby is age 5 to 8 months old.) Approximately 10 days after vaccination, 10-18 bumps appear on the skin where the needles were inserted. The bumps then fester slightly, and become scars after 3-6 months. On rare occasions, side effects such as swelling of the lymph nodes under the arms or continued festering on the vaccine spot after 3 months occur, but these symptoms usually subside if the area is kept clean.

C

Chemoprevention

Also called “chemoprophylaxis” or more recently “latent TB infection treatment,” this treatment is conducted to reduce the possibility of someone who is infected with TB producing symptoms. In Japan, chemoprevention is administered to people of all ages confirmed recently infected with TB, as well as the following high-risk people:

  1. 1People who have spontaneously recovered from TB without treatment
  2. 2People who have a condition related to TB pathogeny (such as diabetes) and are suspected to be infected with TB
  3. 3People who are HIV positive or are undergoing immunosuppressive treatment (adrenal corticosteroid treatment, etc.) and are suspected to be infected with TB

The treatment involves administering the anti-TB medication Isoniazid for 6 months. The treatment is 50-80% effective at preventing TB outbreaks, and its effects are said to last for a lifetime if it is administered immediately after infection. See “Latent TB infection treatment”.

D

DOTS (Directly Observed Treatment, Short-Course)

An anti-TB strategy formulated by the WHO in order to find and cure TB patients. Its main components are:

  1. 1The government must recognize TB as a serious problem and assume an appropriate leadership role
  2. 2Promotion of diagnosis by bacteria testing and follow-up appointments
  3. 3To make sure patients do not forget to take their medicine, they must take it in front of medical professionals
  4. 4Reliable provision of drugs
  5. 5Monitoring and evaluation of the course of treatment

Often only 3 of these components are referred to, but the DOTS strategy is actually as comprehensive as shown above.

Airborne infection (Droplet nuclei infection)

This type of infection happens when the liquid part of a cough or sneeze containing viruses or bacteria evaporates, scatters as small particles, and remains floating in the air until someone breathes it in. Depending on how the air containing the droplet nuclei moves, such an infection may spread across a wide area.

E

Extensively drug-resistant tuberculosis (XDR-TB)

Tuberculosis due to bacteria that is multiple drug resistant, and also resistant to injection drugs such as Kanamycin (excluding Streptomycin) and new quinolones. More difficult to treat than MDR-TB.

G

Group infection

When one infection source spreads across 2 or more households and 20 or more people are infected with TB, this is called a group infection.

I

Incidence rate

A statistic that shows the number of people with new active cases of a disease in 1 year, per 100,000 people. A basic indicator of the degree of prevalence of a disease.

Interferon Gamma Release Assay (IGRA)

A technique used to detect TB, similarly to the Mantoux test. Involves taking blood and exposing it to an antigen unique to the TB bacterium, then measuring the reaction. One issue with the Mantoux test is that even people who are not infected with TB can test positive if they have received the BCG vaccine, and cannot be distinguished from actual TB patients. The IGRA test does not have this problem, and thus allows for a more accurate diagnosis. The products QuantiFERON and T-SPOT have been developed from 2 different methods based on the same principal, and are covered by Japanese public health insurance. (See “Mantoux test”)

J

Japanese DOTS

In order for the patient to regularly continue the course of treatment prescribed by the attending physician, the attending physician works together with the health department to support the patient throughout the long period from hospitalization to outpatient treatment. Specifically, strategies are conceived to make sure the patient continues to receive regular treatment even after leaving the hospital. For example, the patient may be asked to take his or her medicine in front of medical staff. During outpatient treatment, a health department staff member (usually a public health nurse) ensures drug administration in various ways in accordance with the circumstances of the patient and the region. This has also been codified in the law.

L

Latent tuberculosis infection treatment

Also called “chemoprevention” or “chemoprophylaxis,” this treatment is conducted to reduce the possibility of someone who is infected with TB producing symptoms. In Japan, chemoprevention is administered to people of all ages confirmed recently infected with TB, as well as the following high-risk people:

  1. 1People who have spontaneously recovered from TB without treatment.
  2. 2People who have a condition related to TB pathogeny (such as diabetes) and are suspected to be infected with TB.
  3. 3People who are HIV positive or are undergoing immunosuppressive treatment (adrenal corticosteroid treatment, TNF-α inhibitor treatment, etc.) and are suspected to be infected with TB.

The treatment involves administering the anti-TB medication Isoniazid for 6-9 months. The treatment is 50-80% effective at preventing TB outbreaks, and its effects are said to last for a lifetime if it is administered immediately after infection.

M

Mantoux test

A test that determines whether or not someone is infected with TB. Involves injecting a component of the TB bacterium (tuberculin, also called PPD) into the skin. 48 hours later, redness and swelling in the skin is measured. If the affected area reaches a certain size, the test result is positive. This test is especially useful for babies. (See Interferon Gamma Release Assay (IGRA))

Miliary tuberculosis

When bacteria flow from lesions in the lymph nodes and lungs into the venous blood, TB bacteria can spread throughout the entire body. This is called miliary tuberculosis because the individual bacteria stuck in the lung tissue can create countless little lesions that look like millet seeds. This disease can now be cured with chemotherapy administered in a timely manner.

Multidrug-resistant tuberculosis (MDR-TB)

Multidrug-resistant tuberculosis is defined as a type of TB bacteria that is resistant to both of the most important TB treatment drugs, Isoniazid and Rifampicin.

O

Osteoarticular tuberculosis (Pott's disease, etc.)

When TB bacteria attach to the bones or joints and form tuberculous lesions in the skeletal tissue, the bones are destroyed. Pott's disease is the most frequent variation. In this disease, the bones press into the nerves and cause pain, and the back becomes deformed. Osteoarticular tuberculosis also occurs frequently in the hip and knee joints.

P

Pleura

The membrane that covers the surface of the lungs and chest wall. Between the lungs and the chest wall, the pleura forms the pleural cavity, which helps the lungs to breathe smoothly.

Public aid

TB treatments are subsidized by the government. This is done to prevent the situation whereby a patient is unable to continue treatment due to financial circumstances, and also so that the government can take responsibility for treatment quality. This is why the attending physician must write down the patient's symptoms and proposed course of treatment and submit these documents to the public health department along with X-ray films for approval.

Pulmonary tuberculosis

Tuberculosis in the lungs or bronchial tube. 80% of tuberculosis infections are of the pulmonary tuberculosis type.

Q

Quarantine

Patients who risk infecting people around them must be quarantined in a hospital for preventative purposes. In the case of TB, healthcare centers advise hospitalization for patients who are discharging bacteria, mostly those who are smear-positive for pulmonary tuberculosis. This advisory hospitalization is continued in 30 day units based on infectivity evaluations. Recently, the average TB patient is hospitalized for around 70 days, but this average is expected to become shorter in the future.

R

Re-emerging infectious disease

Defined as “a known infectious disease for which patient numbers decreased to the point that it was no longer a public health issue, but started to spread again within 20 years, increasing patient numbers” (World Health Organization). This definition was published in 1990, and so was referring to infectious diseases that became problematic again after 1970. Tuberculosis is also classified as a re-emerging infectious disease.

Relapse

Refers to a new breakout of an illness that was once cured. Relapse is especially likely to occur if initial treatments were not carried out thoroughly, or if the illness was resistant to drugs.

Renal tuberculosis

When tuberculous lesions form in the kidneys, TB bacteria get mixed into the urine and reach the bladder, resulting in TB bladder inflammation symptoms. If this disease progresses, the kidneys will fail.

S

Surveillance

Unlike general infectious diseases, Japanese law has some special requirements for TB surveillance. Rather than simply monitoring outbreak trends, the government can also evaluate patient clinical courses and related medical countermeasures.

T

TB countermeasures based on the Infectious Diseases Control Law, Japan

TB countermeasures used to be conducted according to the Tuberculosis Prevention Act established in 1951, but since 2007, these countermeasures are conducted according to the Infectious Diseases Control Law along with other infectious diseases. TB is classified as a Category 2 Infectious Disease, and countermeasures (notifications of infection, handling of disease-causing agents, infection prevention, quarantine, aggressive immunity testing, physical exams, etc.) are prescribed accordingly. Unlike the other infectious diseases addressed in this law, TB is also classified as a chronic infectious disease, for which special measures such as patient registration, medical fee subsidies, and physical examinations are also required.

The Japan Anti-Tuberculosis Association and Stop TB Partnership Japan

The Japan Anti-Tuberculosis Association was established in 1939 in order to support the government's anti-TB initiatives in the private sector. The association has branches in every prefecture in Japan. It works to spread awareness of TB and TB prevention, and has also established the Research Institute of Tuberculosis to research TB countermeasures.
As global TB countermeasures strengthened and the trend of early eradication gathered pace, the Japan Anti-Tuberculosis Association and other private organizations rallied together to increase the involvement of the government and the medical world, and founded Stop TB Partnership Japan in November 2011.

Tuberculosis hilar lymphadenitis

There are many lymph nodes (hilar lymph nodes) where the trachea splits into the right and left lungs. With this disease, TB bacteria that have multiplied in the lungs catch a ride on the lymph stream to reach these lymph nodes (regional lymph nodes) and cause an infection. This type of TB has often occurred in children.

Tuberculous cervical lymphadenitis

When the TB virus enters the lymph nodes on the side of the neck or the collarbone cavity and creates tuberculosis lesions, this results in lumps that can be detected by touching the outside of the neck. If left alone, the lymph nodes will fester with pus and burst, leaving behind tightened skin and scarring.

Tuberculous meningitis

When TB bacteria reach the meninges (a set of membranes that enclose the brain) through the bloodstream and create lesions, this can result in severe symptoms such as convulsions and impaired awareness. This disease is especially common in infants who have not received the BCG vaccine. Once the disease becomes active, 1/3 of patients die and 1/3 suffer severe permanent damage even if treated. Cases have recently been seen in middle aged and older people as well.

Tuberculous pleurisy

The most common type of extrapulmonary tuberculosis. Inflammation near the lung surface and of the hilar lymph nodes reaches the pleura, and water (leachate) remains in the space between the lungs and the chest wall (the pleural cavity).
Fevers and chest pain are common in the initial stages of the illness, and large amounts of water in the chest may cause shortness of breath.

W

WHO (World Health Organization)

A specialized agency of the United Nations that is concerned with international public health. The WHO helps make health-related agreements between member countries, provides aid, and promotes research. Over 190 countries and regions are currently members. Headquarters located in Geneva.

X

Extensively drug-resistant tuberculosis (XDR-TB)

Tuberculosis due to bacteria that is multiple drug resistant, and also resistant to injection drugs such as Kanamycin (excluding Streptomycin) and new quinolones. More difficult to treat than MDR-TB.

Tuberculosis - An Old Disease with a New Face