Mycobacterium avium-intracellulare complexによる肺感染症の臨床像

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Following previous report (Co-operative Study Group of Japanese National Chest Hospitals on ‘Atypical’ Mycobacterioses: Kekkaku, 49: 139-145, 1974), the second co-operative study was carried out on 77 patients with lung disease due to M. avium-intracellulare who were found in the year 1974-1975 in 11 participating hospitals. All patients were diagnosed in our hospitals. Screening for mycobacteria other than tubercle bacilli was carried out by use of PNB medium, p-nitrobenzoic acid-Ogawa egg medium (Tsukamura, M. and Tsukamura, S.: Tubercle, 45: 64-65, 1964). One hospital used salicylate medium (Tsukamura, M.: Amer. Rev. Resp. Dis., 86: 81-83, 1962) for screening. 1. The disease was defined by more than three times excretions of the organisms during a year, which were in accordance with presence of clinical symptoms. The amount of growth on isolation medium was more than 100 colonies at least in two isolates (Table 1). 2. The M. avium-intracellulare strains showed usually resistance to all antituberculous agents, but a small number of strains showed susceptibility to a few agents (Table 2). However, the agents were not effective clinically, including the agents to which the organisms remained susceptible 3. Male/female ratio of patients with disease was 2.3. There was no significant difference between the ratio of the present patients and the ratio in tuberculous patients. Average age of female patients with disease due to the organisms was 67.1±13.3 years and that of tuberculous female patients was 51.4±17.4 years. The patients with disease due to M. aviunt-intracellulare were significantly older than tuberculous patients (p less than 0.1%by I-test) (Table 3). 4. Preceding diseases and complications are shown in Table 4. Out of 77 patients, 31 previously had tuberculosis. Of these, two had excreted M. tuberculosis. In others, bacteriological identification had not been done. The patients may have secondary infection with M. aviunt-intracellulare (Tsukamura, M.: Jap. J. Chest Dis., 32: 23-36, 1973). General and local complications were observed in 28 patents (36%). This ratio of complications is similar to the ratio previously obtained (31%). Fibrosis, silicosis, pneu moconiosis, asthma and bronchiectasis seem to be important as local factors, as these produce stagnancy of bronchial secretion in respiratory tract. Diabetes was found in 3 patients. 5. X-ray picture (Table 5). Out of 77, 66 (86%) could not be differentiated from lung tuber culosis in X-ray picture. Only 11 (14%) showed some different findings, cavities without pericavitary lesion (Chapman, J.B.: Dallas Med. J., 54: 282-295, 1968). Not only thin-walled cavities but also thick-walled ones were considered as something different. The latter is cavity (cavities) with round outside margin and irregular inside margin. Irregular inside margin probably comes from rest of caseous lesion. 6. Prognosis. During observation periods, 19 (25%) of patients showed negative conversion. These patients received various regimens of chemotherapy. The chemotherapy appeared never effective even if the organisms appeared as if susceptible to a few agents by resistance tests. Therefore, negative conversion is believed to have occured naturally and have not occured as a result of chemotherapy. The negative converted cases did not show improvement in X-ray finding. Only 5 patients showed decrease in cavity size, and other 5 patients died in this year.
日本結核病学会の論文

Mycobacterium avium-intracellulare complexによる肺感染症の臨床像

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