COMPARISON OF CLINICAL PICTURE BETWEEN LUNG DISEASE DUE TO ATYPICAL MYCOBACTERIA AND LUNG TUBERCULOSIS

Abstract

There are many reports on the clinical symptoms and X-ray picture of lung disease due to' atypical' mycobacteria. All these reports, however, lack actual comparison between the mycobac terioses and lung tuberculosis. No report has shown the actual state of clinical picture of lung tuberculosis under present complex chemotherapy. The purpose of the present study is to do this comparison. Clinical picture of 304 tuberculous patients who showed M. tuberculosis once or more in their sputum were studied and compared with those of lung diseases due to M. intracellulare (32 patients) and M. chelonei subspecies chelonei (10 patients). M. tuberculosis was identified by the absence of growth on Ogawa egg medium containing 0.5 mg/ml p-nitrobenzoic acid.
Occurrence of fever was not significantly different between lung tuberculosis and diseases due to atypical mycobacteria. Occurrence of hemoptysis or hemosputum also showed no significant difference between disease due to M. intracellulare and lung tuberculosis, but they appeared more frequently in disease due to M. chelonei (p<0.05% by chi-square test).
A cavity or cavities with non-sclerotic wall which appeared as thin -walled cavities was observed more frequently in diseases due to M. intracellulare and M. chelonei than in lung tuberculosis. Approximately 60% of Japanese tuberculous patients being hospitalized at present showed cavities in sclerotic lesion, while this form was absent in disease due to M. chelonei. The form was observed in ca. 40% of patients with disease due to M. intraellulare.
Thin-walled cavities in diseases due to atypical mycobacteria almost lacked or showed only a few bronchogenic spread, whereas thin-walled cavities in lung tuberculosis were usually accompanied by infiltrative or fibrocaseous lesion in other lung field. Since thin-walled cavities without pericavitary lesion were not observed in lung tuberculosis, the presence of such cavities may be regarded as a sign of disease due to atypical mycobacteria.
As reported previously, Tsukamura divided X-ray pictures of lung disease due to M. intracellulare into two groups. The first showed a marked tendency to caseation and lacked fibrotic process, and the second showed cavities in sclerotic lesion. Tsukamura suggested to correlate the former with the primary infection to healthy lungs and the latter with the secondary infection to open-negative cavities after healing of tuberculosis. This grouping of X-ray features was recognized also in the present study