Pulmonary tuberculosis and non-recent immigrants in Japan – some issues for post-entry interventions

Foreign-born persons are considered one of the high-risk populations for tuberculosis (TB), and numerous studies have discussed the potential role of pre-entry TB screening for immigrants. However, rates of TB disease among immigrants can remain high several years after entry. In Japan, approximately 50% of TB among foreign-born persons occurs among those who have entered Japan more than five years before being diagnosed, i.e. non-recent immigrants. However, little attention has been paid so far to the issue of TB control among the non-recent immigrants. A detailed analysis of the Japan Tuberculosis Surveillance data was therefore conducted to describe the characteristics of TB among non-recent immigrants and discuss policy implications in terms of post-entry interventions in Japan. The main findings were as follows: 1) the proportion of pulmonary TB cases aged 65 years and older was higher among non-recent than recent immigrants (9.8% vs 1.2%); 2) the proportion of those with social risk factors including homelessness and and being on social welfare assistance was higher among non-recent than recent immigrants; and 3) the proportion of those detected via routine screening at school or workplace was significantly lower among non-recent immigrants aged between 25 and 64 than among recent immigrants in the same age group (15.4% vs 28.7%). Our results suggested the need to increase the opportunities for and simultaneously improve the take-up rate of community-based screening for non-recent immigrants.

Tuberculosis in foreign students in Japan, 2010–2014: a comparison with the notification rates in their countries of origin

This study characterizes the foreign students with tuberculosis (TB) registered in Japan from 2010 to 2014 and compares their TB notification rates with those in their countries of origin. The TB notification rates in foreign students were retrieved from the National Epidemiological Surveillance of Infectious Disease system in Japan. National TB notification data from 16 countries and areas were extracted from the World Health Organization’s and the official health websites of the countries and areas. There were 1128 foreign students in Japan who developed TB between 2010 and 2014; nearly half of the cases were from China ( = 530, 46.9%), and 688 (61.0%) were male with a median age of 23 years. The TB notification data for foreign students were highest in students from the Philippines (675/100 000 person years, 95% confidence interval: 372–977). The notification rates in foreign students from seven countries were significantly higher than the average notification rate in their countries of origin (China, Indonesia, Mongolia, Myanmar, Nepal, the Philippines and Viet Nam). The Republic of Korea and Taiwan, China had significantly lower rates in foreign students than in their countries of origin. The notification rates for foreign students in Japan may reflect a more accurate risk of developing TB among the immigrants to Japan than the TB notification rates in their countries of origin. These results may be helpful to identify the immigrants’ countries/areas of origin with the necessity of pre-entry TB screening.

Successful Surgical Management of Lipoma in the Right Ventricle / 日本心臓血管外科学会雑誌

We report a rare case of lipoma arising from the right ventricle. A 66-year-old woman was admitted to our hospital for exertional chest pain and fatigability. She was diagnosed of mild aortic stenosis and regurgitation (ASR), mild mitral regurgitation (MR), and asymptomatic cardiac tumor in the right ventricle about two years previously, for which she had been followed up at other local hospital. A recheck transthoracic echocardiography revealed moderate MR. No evidence of deterioration of ASR and cardiac lipoma were detected. The patient underwent mitral annuloplasty and replacement of aortic valve, plus resection of the right ventricle tumor through the tricuspid valve. Pathological examination of the resected tumor showed mature adipose tissue infiltrated into normal cardiac muscle without atypical cells, which suggested intramyocardial lipoma. Postoperative course was uneventful. Fourteen months after the operation, the patient remains asymptomatic and regular echocardiographic checkup demonstrates no tumor recurrence or residual MR.

An Operative Case of Papillary Fibroelastoma of the Aortic Valve / 日本心臓血管外科学会雑誌

An echocardiogram revealed a mobile mass attached to the left coronary cusp of the aortic valve in an 81-year-old woman. The tumor was surgically removed without valve replacement. The tumor was whitish in color, with a sea anemone-like appearance, and it measured 10 mm in maximum dimension. It was histopathologically defined as papillary fibroelastoma (PFE), and the postoperative course was uneventful. Primary cardiac tumors are rare, and the majority are myxomas. However recent advances in noninvasive examination and surgery may increase the detection of PFE, which occurs most frequently on the endocardial surface of the cardiac valve. We report a case of cardiac PFE with a review of the pertinent literature.