Mycobacterium fortuitum による肺感染症 (3症例の報告)

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The criteria for diagnosing lung disease due to atypical mycobacteria according to Tsukamura (Kekkaku, 53: 367-376, 1978) were adopted to diagnosis of lung disease due to Mycobacterium fortuitum. The criteria were set up based on the isolation rate of casual isolates of atypical mycobacteria in tuberculous patients (background-isolation rate). Simultaneous occurrences of the isolation of atypical mycobacteria belonging to the same species at a rate higher than the background-isolation rate (0.01 per examination) and of the appearance of fresh cavitary lung lesion were believed to indicate the presence of infection, as such simulta neous occurrences in the same patient at the same time are surely to be extremely rare, if they are independent of each other.<BR>Case 1 (55-year-old male manager) showed cavity with pericavitary infiltrative lesion in the left upper lobe and three times-isolation of M. fortuitum, each time more than 100 colonies, and was diagnosed as suffering from lung disease due to this organism.<BR>Case 2 (35-year-old male welder) showed a round infiltrative lesion in the left lower lobe and twice-excretion of M. fortuitum and was diagnosed as suffering from disease due to this organism.<BR>Case 3 (65-year-old male without occupation) showed a thin-walled cavity in the right upper lobe since five years and then showed twice-excretion of M. fortuitum. In this case, appearance of cavity did not occur together with the appearance of the organism, and the diagnosis was not sure. However, it is known that lung diesase due to M. avium-M intracellulare complex may show often open-negative, thin-walled cavity (Tsukamura, M.: Kekkaku 51: 369-372, 1976; 56: 361-368, 1981). Considering this fact, it is possible that this case has disease due to M. fortuitum.<BR>Case 4 (65-year-old male carpenter) had shown excretion of M tuberculosis from cavity in fibrocaseous lesion in the left upper lobe. Sixteen months after the disappearance of M. tuber culosis from sputum, M. fortuitum appeared in his sputum. The excretion of M. fortuitum was shown seven times during a period of 25 months. After the appearance of M. fortuitum, dete rioration of X-ray picture occurred showing progressive caseation. This case was considered as a case of secondary infection by M fortuitum to open-negative cavity of tuberculosis.<BR>Case 5 (57-year-old male, ex-molding worker) suffered from lung tuberculosis, but M. tuber culosis disappeared from sputum since ten years. Chest X-ray showed sclerotic lesion containing a cavity remaining in the right upper lobe. This patient showed four times-excretion of M. fortuitum without showing any deterioration of the X-ray picture. The case was considered as a case of paratism or colonization.<BR>Out of the above three cases who were considered to have disease due to M. fortuitum, two cases (cases 1 and 2) belonged to the primary infection-type and showed the disappearance of the lesion and the organism within six months. On the other hand, one case (case 4) of the secondary infection-type showed neither improvement of X-ray picture nor disappearance ofthe organism during the period of observation.<BR>No specified characteristics of X-ray picture of the lung disease due to M. fortuitum could be observed, and the X-ray picture was similar to that of lung tuberculosis.
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