[A case of bronchial asthma caused by occupational exposure to trichophyton].

A case involved a 39-year-old female nurse in a health-care facility for elderly individuals requiring long-term care, who presented with insufficient control of bronchial asthma. Although she did not have tinea, she had opportunities for contact with patients who did. Careful interview of history suggested a relationship between asthma exacerbation and workplace, so we measured the specific IgE antibody to Trichophyton and confirmed a positive result. As occupational exposure to Trichophyton was considered as a cause of asthma exacerbations, avoidance of Trichophyton as well as anti-asthma treatment was conducted and symptoms improved. Identification and avoidance of specific allergens is essential for successful long-term management of asthma. However, measurement of specific IgE antibody to Trichophyton is not routinely performed, although this fungus could induce not only tinea, but also asthma. The possibility that occupational exposure to trichophyton could exacerbate asthma symptoms needs to be kept in mind, particularly in the case of nurses who may be in contact with elderly individuals with tinea.

[Current status of the criteria for discharging patients with pulmonary tuberculosis--results of questionnaire survey on the criteria for discharging patients from tuberculosis wards of the hospitals in Kanto area].

INTRODUCTION: Emphasis in treating patients with infectious pulmonary tuberculosis has come to be laid on the execution of reliable standard chemotherapy. As a result, hospitalization for a prolonged period has become unnecessary any more. However, few attempts have been made so far on the determination of discharging criteria. METHODS: We performed a questionnaire survey to hospitals with wards for tuberculosis in Kanto area and asked questions on the current status of discharging criteria. RESULTS: The effective response rate to the survey was 63.0 %. Sputum smear examination carried out mainly by Ziehl-Neelsen method and fluorescence method in 17.2% and 72.4 % of the hospitals, respectively. Sputum culture examination was carried out using mainly Ogawa medium and a liquid medium in 62.1% and 27.6% of the hospitals, respectively. Discharging criteria were standardized in 79.3% of hospitals. Negative sputum smear was used as the criterion for determining discharge in 11 sets of criteria. Negative sputum culture was used as the criterion for determining discharge in 17 sets of criteria. In the remaining one hospital, patients were to be discharged after 2-month treatment. There was no consistency in the procedure and the frequency of sputum examinations, how many negative results are needed to confirm negative status and the criteria for judgment. CONCLUSION: These results suggest that further evaluation must be made on the treatment outcome at each hospital, and the standard discharging criteria should be worked out taking into account the capacity of each hospital and the care situation of local community.