| 特集名 | 透析室の感染症へどう対応するか | |
|---|---|---|
| 題名 | 透析患者の結核感染―早期発見と院内感染防止対策 | |
| 発刊年月 | 2018年 06月 | |
| 著者 | 長谷川 廣文 | けやきクリニック |
| 【 要旨 】 | 日本の結核新規登録患者は年とともに減少し2016年の罹患率（人口10万対）は13.9人となったが，透析患者では，細胞性免疫の低下などのため結核の罹患率が依然として高く，大阪の透析施設での罹患率（人口10万対）は2013年には235人であった． 平成28年に結核に関する特定感染症予防指針が改訂された．この改訂内容をもとに，①BCG接種の影響を受けず，特異度，感度とも高い，ϒインターフェロン遊離試験（interferon gamma release assay；IGRA）の解説と適応，②透析患者，医療従事者での潜在性結核感染症（latent tuberculosis infection）の診断と治療適応，③透析患者での結核感染の早期発見の重要性，④ハイリスク接触者と濃厚接触者の対策，⑤院内感染防止対策について述べた． |
|
| Theme | Dealing with infections in hemodialysis facilities | |
|---|---|---|
| Title | Tuberculosis infection in patients undergoing dialysis-early detection and prevention of hospital-associated infection | |
| Author | Hirofumi Hasegawa | Keyaki Clinic |
| [ Summary ] | In 2016, the notification rate of tuberculosis was 13.9 per 1,000,000 population in Japan. Although this rate has been persistently declining over the past few years, the prevalence of tuberculosis remains high in patients undergoing dialysis owing to lowered cell-mediated immunity in this patient population. The notification rate of tuberculosis in patients undergoing dialysis was 235 per 1,000,000 population across dialysis facilities in Osaka in 2013. In this article, we have described the use of the interferon gamma release assay, and the diagnosis and treatment of latent tuberculosis infection in patients undergoing dialysis and in healthcare providers. Moreover, we have discussed the importance of early detection of tuberculosis infection in patients undergoing dialysis, the measures to be implemented in high-risk and close contacts of patients, and the preventative measures against hospital-associated tuberculosis infection. |
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