[Transmission of tuberculosis (II)]

In the previous paper (Kekkaku. 2004; 79: 509-518), the author has made a review on (1) development of droplet nuclei infection theory, (2) experimental basis and (3) epidemiological evidence of droplet nuclei infection, and has discussed about the factors influencing on tuberculosis infection. Various mode of transmission of tubercle bacilli from nonpulmonary sources was reviewed in the present paper, such as (1) infection from cutaneous tuberculosis, (2) infection in the bacteriology laboratory, (3) infection by needle stick, (4) transmission by bronchoscopic examination, (5) tuberculosis infection in the autopsy room, (6) infection followed vaccination and/or cortico-steroid injection therapy, (7) congenital tuberculosis, and (8) other rare transmission of tuberculosis. Moreover, three topics concerning tuberculosis infection were discussed, they are (1) tuberculosis infection risk index, (2) highly infectious case, and (3) virulence and infection. Infection risk index is the product of smear positivity (expressed by Gaffky Grading) by duration of cough (expressed by month). This index is being used widely at the occasion of contact survey at present in Japan so that instructions for use were discussed.