[TUBERCULOSIS ANNUAL REPORT 2013--(3) Case Finding and Condition of Tuberculosis on Diagnosis].

In 2013, tuberculosis (TB) case findings from the nationwide TB surveillance data in Japan were reviewed with regard to the mode of detection, symptom at diagnosis, diagnostic delay, proportion of far-advanced cavitary lesions, co-existence of human immunodeficiency virus (HIV) infection and diabetes mellitus (DM), and drug susceptibility testing (DST). Among the 20,495 new TB cases in 2013, 83.1% were diagnosed when the patients sought medical attention for TB symptoms or attended medical facilities because of other chief complaints. Among the 15,972 patients with pulmonary TB, 26.4% had only respiratory symptoms, 30.5% had respiratory and non-respiratory symptoms, 17.8% had only non-respiratory symptoms, and 24.5% were asymptomatic. The proportion of patient and doctor delays among the 11,933 symptomatic pulmonary TB cases was analyzed. A large proportion--around 30%--of patients aged 45-54 years with symptomatic pulmonary TB exhibited a patient delay of ≥ 2 months. The proportion of patients with a total delay (i.e., the sum of patient and doctor delays) of ≥ 3 months exhibited a similar tendency to that of those with a patient delay. The proportion of patients aged ≥ 65 years with a doctor delay of ≥ 1 month surpassed that of age-matched patients with a patient delay. Among symptomatic smear-positive TB, a patient delay of ≥ 2 months exhibited a bimodal distribution, and its peak was > 35%. The proportion of patient delay in those aged 30-39 years decreased compared to that of recent years. Meanwhile, the proportion of patients--approximately 15%--with a doctor delay of ≥ 1 month was relatively stable across all the age groups. The proportion of patients with pulmonary TB who had far-advanced cavities in the lungs increased from 1.5% in 1975 to approximately 2% and then remained stable from 1985 to 2013. Among the 50 new TB cases with HIV in 2013, 5 occurred in women and 10 in foreigners. From 2007 to 2013, there were 416 patients with newly diagnosed TB and HIV infections, 359 (86.3%) and 57 (13.7%) of whom were men and women, respectively, including 86 (20.7%) foreigners. The proportions of newly diagnosed TB cases with DM in 2013 were 14.5% (2,964/20,495), of which 16.6% (2,072/12,504) occurred in men and 11.2% (892/7,991) in women. The DST results were obtained through the surveillance system for 7,701 (73.2%) of 10,523 culture-positive pulmonary TB cases in 2013. In previously untreated patients, the proportions of patients with multi-drug resistant TB, any isoniazid resistance, and any rifampicin resistance were 0.4%, 4.5%, and 0.6%, respectively; meanwhile, in previously treated patients, the proportions were 3.7%, 8.0%, and 5.1%, respectively. In previously untreated patients, the proportions of multi-drug resistant TB and any isoniazid resistance decreased comparing with 2012.