Lessons learned from earthquake-related tuberculosis exposures in a community shelter, Japan, 2011.

BACKGROUND: Refugees and displaced populations after natural disasters have been vulnerable to tuberculosis. We report an active pulmonary tuberculosis case at a shelter and the subsequent contact investigation and review lessons learned from the 2011 Great East Japan Earthquake. METHODS: The contact investigation was conducted to identify latent tuberculosis infection among a total of 95 contact persons, including 78 evacuees at the shelter, who were exposed to the index tuberculosis patient. The association between exposure time of contacts to a patient with active tuberculosis and results of interferon-γ release assay (IGRA) was also examined. RESULTS: IGRA was positive in 9 (12.3%) of 73 evacuees at the shelter. Contacts who were exposed to active tuberculosis for more than 25 days were significantly more likely to be IGRA positive, compared with contacts exposed for less than 20 days. All of the 4 evacuees with latent tuberculosis infection who initiated treatment completed the regimen successfully. CONCLUSION: When a disaster strikes and many people are living in shelters, it is essential for health care personnel to first suspect tuberculosis and implement prevention and control in collaboration with referral hospitals and public health centers.

Tuberculosis exposure among evacuees at a shelter after earthquake, Japan, 2011.

Tuberculosis was diagnosed in a person who had stayed in a shelter after the 2011 Great East Japan Earthquake. A contact investigation showed that the prevalence of latent tuberculosis infection among other evacuees at the shelter was 20%. Our report underscores the importance of tuberculosis prevention and control after natural disasters.

Chest wall abscess due to Mycobacterium bovis BCG after intravesical BCG therapy.

We report a case of chest wall abscess caused by Mycobacterium bovis BCG that arose as a complication 1 year after intravesical BCG instillation. We identified M. bovis BCG Tokyo 172 in the abscess by PCR-based typing of Mycobacterium tuberculosis complex and analysis of variable number of tandem repeats data.

Systemic to pulmonary venous shunt in lung cancer with obstruction of superior vena cava: case report with review of the literature.

We describe the CT features of an unusual collateral pathway of systemic to pulmonary venous shunt in a patient with lung cancer that obstructed the superior vena cava (SVC). Spiral CT scan with rapid injection of contrast medium from a right arm vein revealed a systemic to pulmonary venous shunt (SPVS), passing through thick pleural effusion, which was the direct transpleural communication between right upper chest wall veins and right superior pulmonary veins. Three-dimensional CT angiography revealed the entire shunt. We consider that the shunt was formed in association with radiation therapy, and was not injured with the subsequent collapse of the lung and accumulation of massive pleural effusion. We review the reports that have dealt with the shunt in patients with lung cancer, and discuss the conditions related to the development of SPVS in such patients.

Two cases of thoracopancreatic fistula in alcoholic pancreatitis: clinical and CT findings.

We report two patients who were long-time habitual consumers of alcohol and suffered from thoracopancreatic fistula. The first patient, a 52-year-old man with no symptoms, underwent chest CT scan for a medical check-up and was revealed to have left small pleural effusion. A month later, he suddenly experienced severe cough and back pain. The immediate CT scan showed massive pleural effusion and mediastinal pseudocyst, and the amylase level in the aspirated pleural effusion proved to be elevated. He was successfully treated with medication and drainage of the effusion. The second patient, a 39-year-old woman, underwent CT scan for a medical check-up, and it disclosed that she had a small pleural effusion in the left lower thorax. Follow-up CT two months later revealed the pleural effusion to be resolved, however, it demonstrated that a narrow tract derived from the pancreatic secretion located just posterior to the pancreatic tail extended to the mediastinum along the left hemidiaphragmatic crus. She experienced severe cough and sputum four months later. CT scan showed massive pleural effusion in the left thorax and revealed that the pancreaticopleural fistula was located in the same position as the small tract that had been detected by the previous CT scan. The patient received conservative treatment and eventually recovered from the severe chest complications. We consider that asymptomatic left small pleural effusion in these patients who were habitual drinkers is a potential precursor to symptomatic pancreatitis. The patients developed mediastinal pseudocyst and pancreaticopleural fistula in association with chronic pancreatitis within a few months, and therefore intensive follow-up should be undertaken to minimize or prevent chest complications in association with the subsequent symptomatic pancreatitis.