II. NONTUBERCULOUS MYCOBACTERIOSIS; THE PRESENT STATUS AND IN THE FUTURE

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In the past decade, the non-tuberculous mycobacterial (NTM) infection was a rare disease but now is the common and increasing pulmonary infection in Japan. It is suspected that about 16% of patients with positive AFB in their sputa are the NTM patients. It is well known that disseminated M. avium complex infection is an important complication of HIV disease. It will be worth to summarize some basic and clinical topics of this infectious disease in this symposium. The profiles of the antimicrobial action of microbicidal effector molecules against Mycobacterium avium complex (MAC) were presented by Dr. Tomioka, who reported the collaborating effect of reactive nitrogen intermediates with free fatty acids is crucial for macrophage-mediated intracellular killing of AFB. In addition, the auther discussed some important roles of type II alveolar epithelial cells as a target cell for primary invasion of AFB in the host lungs. Dr. Koga reviewed the clinical usefullness of Amplicor, one of commercially available PCR detection kits for MAC. The MAC was detected in clinical samples such as sputum, bronchial washing fluids and gastric juice with 5 to 10% in frequency. The 60% to 80% of MAC positive cases were finally diagnosed as MAC disease and treated. He recommended that the positive result of genetic diagnostic method such as Amplicor should be carefully considered for clinical use. Dr. Kurashima summarized the short term effects of chemotherapy for pulmonary MAC infection. The auther analysed the 170 MAC cases treated with multi-drug chemotherapies which had not changed for 6 months or more. At 2 months after starting chemotherapy, 57.1% of patients obtained negative conversion but at 6 months only 28.9% remained bacilli negative. He recommended the regimen with combination of more than 3 drugs including aminoglycosid and clarithromycin. Two authers supplemented additional comments. Dr. Shigeto reported the long-term prognosis of MAC disease, indicating 64.7% obtained negative conversion and 35.5% remained bacteriologically negative in 71 patients who treated with at least 3 drugs and for more than 12 months. In addition, in the 12 patients who underwent surgical therapy, only one patient deteriorated. Dr. Kawahara precisely reported the basic preclinical evaluation of promising new drugs including new quinolones and new macrolides and Rifamycins. He also reviewed the clinical impact of these drugs. The present status of HIV infection and NTM in Japan was presented by Dr. Mizutani. All of 32 reported cases are male, in which 23 were with MAC and 6 were with M. kansasii disease. The 3 cases in 4 without bacteremia were patients with M. kansasii. The Mean count of CD 4+ lymphocytes in the peripheral bloods of these 32 patients was only 11/mm3. As additional comments, the geographical distribution in environment and serovars of MAC were reported by Dr. Saito. It was not found that the difference in the geographic distribution between soil MAC and disease-associated MAC. The 55% of soil MAC reacted with the AccuProbe MAC but not with the AccuProbe M. avium and M. intracellulare. The auther also demonstrated that 38 MAC strains isolated from 38 Japanese AIDS patients were all M. avium and serovars of Japanese MAC from AIDS patients are similar to those of the American MAC strains from such patients.
一般社団法人日本結核病学会の論文

II. NONTUBERCULOUS MYCOBACTERIOSIS; THE PRESENT STATUS AND IN THE FUTURE

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