<I>Mycobacterium avium-Mycobacterium intracellulare</I> Complexによる肺感染症のX線像の特徴

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1. Classification of X-ray Feature<BR>The X-ray feature of lung disease due to <I>M ycobacterium avium-M. intracellulare</I> complex (<I>M. avium</I> complex) has been classified into three types: (1) Primary infection type; (2) secondary infection type; (3) intermediate type. The first type is characterized by a fresh solitary cavity (cavities), and it may accompany pericavitary infiltration or caseous lesions. The cavity is usually thin-walled. The second type shows cavities in sclerotic lesion or cavities with sclerotic wall and is not differentiable from tuberculous cavities. The third type shows cavities with fibro-caseous lesions and is not differentiable from tuberculous cavities.<BR>Out of these three types, only the first type is differentiable from tuberculosis, and shows in along-term observation the following characteristics: Marked tendency to caseation and deficiency of fibrotic process (Tsukamura, M.: Kekkaku, 50: 17, 1975).<BR>Patients who were hospitalized in this hospital were classified as follows: Primary infection type, 32 (51%); secondary infection type, 28 (44%); intermediate type, 3 (5%).<BR>2. Diagnosis<BR>Cases showing X-ray findings peculiar to the primary infection type was diagnosed as the disease when two or more positive cultures of the same species were isolated in 3 to 12 daily examina tions of the sputum conducted in the first month of hospitalization or in 3 monthly examinations. The reason for this diagnostic criterion is as follows: Previously, the present author (Tsukamura, M.: Kekkaku, 53: 367, 1978) estimated the casual isolation rate of atypical mycobacteria from sputum specimens of tuberculous patients as 0.01 per one examination. The isolation rate of atypical mycobacteria, in tuberculous patients, who have cavities and bronchiectasis, is expected to be higher than healthy persons. Two or more positive results mentioned above could hardly be regarded as casual, as they are significantly higher than the back ground-isolation rate, 0.01. Co-existence of the abnormal isolation of atypical mycobacteria and the abnormal clinical symptom (appearance of cavities) in the same person is considered to be related to each oether, as it should be extremely rare that such co-existence might occur by chance.
日本結核病学会の論文

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束村道雄
国立療養所中部病院

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