クォンティフェロンＴＢ‐２Ｇ検査陰性者から複数の発病者が発生した集団感染事例について

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  • OUTBREAK OF PULMONARY TUBERCULOSIS IN WHICH TUBERCULOSIS DEVELOPED FROM QuantiFERON-TB SECOND GENERATION (QFT-2G) TEST NEGATIVE PERSONS
  • クォンティフェロン TB 2G ケンサ インセイシャ カラ フクスウ ノ ハツビョウシャ ガ ハッセイシタ シュウダン カンセン ジレイ ニ ツイテ

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[Purpose] To clarify the points to be considered when QFT-2G tests are used in the contacts examination by public health center.<BR>[Object & Method] We analyzed the results of contacts examination on 43 workplace colleagues (39 y/o and younger)of a pulmonary tuberculosis patient (bII2, Gaffky 9, cough for 1.5 months).<BR>[Results] After two months of the last contact with the index case, tuberculin skin tests, QFT-2G tests and chest X-rays were undertaken. After 6 months, chest X-rays were taken, and after 9 months, QFT-2G tests and chest CT scans were also undertaken.<BR>The tuberculin skin tests after two months showed a bimodal distribution, and 10 were QFT-2G positive and 2showed doubtful reaction. The latter 12 persons underwent chemoprophylaxis. After 6 months, however, out of 31 QFT2G negative persons, 2 developed pulmonary tuberculosis. Moreover, after 9 months, chest CT scans revealed 5 pulmonary tuberculosis patients. Three out of 7 new patients showed positive or doubtful reactions in QFT-2G tests undertaken after 9 months.<BR>[Dis cussion and Conclusion] The sensitivity of QFT-2G tests is reported to be 80 to 90%, and the possibility of false negative is not negligible. We propose measures for public health center to conduct the contacts examination as follows; In case of high QFT-2G positive (including doubtful reaction)rate and/or a bimodal distribution of tuberculin skin test result, many infected persons are likely to be included in the group; and the following measures are recommended;<BR>1) Necessity of chemoprophylaxis should be judged considering both tuberculin skin test results and the situation of contact with the index case, and not only by QFT-2G test results.<BR>2) QFT-2G negative persons also need to be followed with chest X-rays.

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  • 結核

    結核 82 (8), 629-634, 2007

    一般社団法人 日本結核病学会

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