非定型抗酸菌排出例の検討

抄録

For the past one year we observed isolation of atypical mycobacteria from sputa of inpatients and outpatients in Nagahama Sanatorium, and we investigated each cases discharging them. The results are summarized as follows:
1) Cases giving out atypical mycoba c t eria were classified by the state of isolation (frequency of the discharge) into frequently, continuously, and sporadically discharging types.
And these 3 types were compared each other with regard to number of cases (Table 4), sex and age (Table 5), previous tubercle bacilli detection and previous chemotherapy for tuberculosis (Table 6), the cavity in chest X-ray findings, and relation between discharge of atypical mycobacteria and change in clinical symptom (Table 7), and type of bacilli by Runyon and maximum number of colonies (Table 8).
2) Under the frequently discharging type were classified those who gave the atypical mycobacteria more than several times in consecutive sputa tests for 5 days without chemotherapy (performed only with inpatients) and in one monthly test. Seven inpatients belonged to this type. Their clinical courses were described. And their chest X-ray findings, chemotherapies and discharges of the atypical mycobacteria were represented in a figure (Figure 1).
All the cases of this type were considered to have pulmonary atypical mycobacteriosis or to be complicated with its disease, since their mycobacteria were isolated frequently and in a large amount, and indicating its relationship to change in the symptoms (inclusive of chest X-ray and other laboratory findings) with discharge of the atypical mycobacteria. In other words, we had no evidence to deny the pulmonary atypical mycobacteriosis in these cases.
In 3 of this type, large amounts of the atypical mycobacteria were isolated only in the consecutive sputa tests at hospitalization. Therefore consecutive sputa tests are considered important for the detection of atypical mycobacteria as well as of tubercle bacilli.
3) Under the continuously discharging type are classified those who g ave the atypical mycobacteria more than 2 times in 3 monthly tests. Nine outpatients belonged to this type. Their chest X-ray findings, chemotherapies, discharges of atypical mycobacteria, and detection of acid-fast bacilli (estimated to be tubercle bacilli) in the past were represented in a figure (Figure 2).
In 3 cases of this type, sedimentation rate of erythrocytes was elevated or symptom altered in association with discharge of the atypical mycobacteria. But in none of this type chest Xray findings indicated excerbation at discharge of them.
Discharge of the atypical mycobacteria in thi s type is assumed to be partly due to: the bacterial alternation-like phenomen, since there were 6 cases that tubercle bacilli were detected in the past and after a certain period of chemotherapy the atypical mycobacteria were found continuously.
4) To the sporadically discharging type belonged those who gave the atypical mycobacteria only once or twice with a interval during the period of the observation. This type was evidently more frequent among outpatients than among inpatients, and number of colonies was small in many of them. But discharge of the atypical mycobacteria in this type too is not considered to be deribed only from contamination, since this type was not found among the young patients.
We want to continue observation on atypical mycobacteria discharging cases in order to contribute to the elucidation of its clinical significance.