X線像からみた<I>Mycobacterium avium-Mycobacterium intracellulare</I> Complexによる肺感染症の空洞と肺結核の空洞の比較

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The present author (Tsukamura, M.: Kekkaku, 50: 17-30, 1975; 56: 23-33, 1981) divided the X-ray picture of lung disease due to <I>Mycobacterium avium-M. intracellulare</I> complex (<I>M. avium</I> complex) into two types: Primary infection type and secondary infection type. Although the X-ray feature of the secondary infection type, which is due to secondary infection of the <I>M. avium</I> complex into tuberculous cavities, could not be differentiated from that of lung tuberculosis, the X-ray feature of the primary infection type was characterized by ‘strong tendency to caseation’ and ‘deficiency of fibrotic process’. In an aid to observe whether the characteristics of the disease due to <I>M. avium</I> complex is based on either host condition (decreased immune response of the host) or parasite condition (different composition of bacterial substances), a comparative study of the X-ray picture was carried out between lung tuberculosis and disease due to <I>M. avium</I> complex in the present study.<BR>Patients who were previously untreated or, if any, treated within three months by chemotherapy and showed rapid conversion of tubercle bacilli in sputum (disappearance of causative organisms by culture within three months) after hospitalization were subjected to the study. The patients showed fresh, non-sclerotic cavitary lesion in their X-ray picture at the hospitalization. Out of 115 patients who had lung tuberculosis, 107 showed rapid conversion of sputum cultures within three months (Table 1). Out of these 107, 99 (92.5%) showed disappearance of cavities within six months after the sputum conversion (Table 3). In contrast, out of 15 patients who had lung disease due to <I>M. avium</I> complex and showed rapid conversion of sputum, 9 (60.0%) showed disappearance of cavities within six months. Furthermore, such comparison was carried out between patients with lung tuberculosis, who were more than 50 years-old, and patients with lung disease due to <I>M. avium</I> complex. The rate of disappearance of cavities in tuberculous patients (40/45 or 88.9%) was much higher than that of patients with lung disease due to <I>M. avium</I> complex (60.0%) (Table 4). It was shown thus that the disappearance of cavities in patients with lung disease due to <I>M. avium</I> complex was rather difficult to occur even when parasite factor was diminished by the sputum conversion.<BR>Previously, the present author (Tsukamura, M.: Kekkaku, 51: 369-372, 1976) reported two cases who showed no acid-fast organism in their sputum for a long time and showed <I>M. avium</I> complex from cavities of resectcd lungs, and one case who showed a thin.walled cavity without showing acid-fastorganism fbr 4 years and then showed.<I>M. avium</I> complex in its sputum persistently. Thin-walled cavi-ties without cxcreting acid-fast organism in sputum were shown in six patients of the present study, and suchfindings may be characteristic fbr lung disease due to <I>M. avium</I> complex.<BR>Furthermore, as an evidence suggesting that the characteristic feature of X-ray picture of lung disease due to <I>M. avium</I> complex is produced by host condition, a peculier case of lung tuberculosis plus <I>diabetes mellitus</I>, who showed a X-ray picture similar to that of lung disease due to Ivl. avium complex, was shown in the present study (Photo. 2).<BR>In conclusion, two factors are considered as the factors which produce the persistence of culturenegative cavities in the lung disease due to <I>M. avium</I> complex: 1) persistence of small amount of <I>M. avium</I> complex organisms in cavity wall, which may appear as culture-negative; 2) host condition with attenuated immune response.
日本結核病学会の論文

著者

束村道雄
国立療養所中部病院

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