Article in Japanese
"A case of infant tuberculous meningitis with an undetected source of infection
̶Considerations from the public health viewpoint̶"
Michiko NAGAMINE1）, Tomoyo NARITA1）, Osamu TOKUNAGA2）,Kaori TSUJI3）, Makoto ISHITATE4）,Takemasa TAKII 5）
A boy was vaccinated with Bacille Calmette Guerin (BCG) at 6 months of age. From that time he had symptoms such as fever and ill temper intermittently, and repeated pediatric consultations. At 10 months of age, vomiting continued for about one week, and a sudden consciousness disorder appeared, so he was transferred to an emergency hospital, where pulmonary tuberculosis with cavities and tuberculous meningitis were diagnosed. Contact investigation did not find any cases of tuberculosis that could be a source of infection in the family, suggesting that it was caused by relatively casual contact. Although the morbidity of tuberculosis in Japan has improved steadily, the chances of tuberculosis infection are not negligible among infants with a limited range of activities. To protect infants who are vulnerable to tuberculosis, it is necessary to ① ensure BCG vaccination during the standard period ② carefully observe and evaluate the Koch phenomenon, and ③ to make a differential diagnosis of tuberculosis for those who have symptoms such as prolonged respiratory symptoms and recurrent fever. In this case, we performed variable number of tandem repeats analysis of the isolated tuberculosis for the purpose of estimating the infection route, and compared it with the strain information from the relevant local governments. However, the source and route of infection could not be identified. To disconnect the chain of invisible infection, it is desirable to establish a pathogen surveillance system and introduce molecular epidemiological analysis using social network analysis.
1）Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government
2）Department of Pediatrics, National Hospital Organization Minami-Kyoto Hospital
3）Infectious Disease Control Centre, Setagaya Public Health Centre
4）Department of Respirology, Tokyo Metropolitan Children’s Medical Center
5）The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association
|Key words||tuberculosis in childhood, BCG vaccination, Koch phenomenon, variable number of tandem repeats analysis, tuberculosis surveillance|
|Received||June 11, 2020|
|Accepted||April 29, 2021|