Tuberculosis sequelae in Japan

Abstract

Tuberculosis had been the leading cause of death in Japan until 1950, and in these days there were about 3 million patients with active tuberculosis every year. From about 1950 to 1960 surgery was the treatment of choice if there were cavities and the lesions were regional. The number of patients who had thoracoplasties and/or pulmonary resections at national sanatoriums during the period of 1954 to 1961 was about 200,000. Since national sanatoriums had about 25% of the total beds for tuberculosis in Japan at that time, the total number of surgically treated patients would be around four times this number, that is 0.8 to 1.0 million. Many of those who survived suffered later from complications, which included chronic respiratory failures, chronic hepatitis (hepatitis C), liver cirrhosis and/or hepatic cell carcinomas. There are at least 50,000 patients who are under home oxygen therapy (HOT) in Japan, of whom about 30% are those with pulmonary tuberculosis sequelae (TBS). The survival rate after the start of HOT in these patients was found better in those who had surgical treatments than in those who had medical treatments only. Since hypercapnea was more common in the former, better survival rates in the hypercapnic than in the normocapnic patients with TBS as a whole could be due to the fact that more of the surgically treated patients were included in the hypercapnic group. For this reason, it is premature to conclude that hypercapnea is an independent favorable prognostic factor in TBS patients with chronic respiratory failure. Because more than one-forth of thoracoplasties and/or pulmonary resections were done in national sanatoriums, it is the responsibility of those who are now working in national hospitals to treat and support these patients with TBS who developed complications such as respiratory failures, chronic hepatitis, liver cirrhosis, and/or hepatic cell carcinomas.