The frequency of mycobacteria isolated from patient's specimens at Showa University Fujigaoka Hospital was investigated.
By fitting a polynominal curve (degree=3) of the annual frequency of culture-positive Mycobacterium tuberculosis (1977 through 1995), it was noted that the frequency had not changed since 1977. The patients in the 40s or older and 60s or older comprised 74 and 38%, respectively. Of 104 patients diagnosed as tuberculosis (between 1993 and 1995), 43 (41%) were compromised hosts with the following underlying diseases: kidney disease; diabetes mellitus ; malignant tumor ; respiratory disease ; Behcet's disease ; ophthalmosarcoidosis; multiple arthritis ; Hashimoto's disease. This suggested that these compromised hosts are at high risk of onset and relapse of tuberculosis, and occasionally the doctor's or patient's delay was seen during the diagnostic process.
By fitting a polynominal curve (degree=3) of the annual frequency of culture-positive atypical mycobacteria (1977 through 1995), it was noted that the frequency had increased since 1981. The patients in the 40s or older and 60s or older comprised 88 and 60%, respectively. Between 1982 and 1994, we encountered 46 cases of atypical mycobacteriosis of the lung: 37 M. avium complex (MAX) diseases ; 7 M. kansasii diseases ; one M. chelonae disease ; one unidentified disease involving Runyon Group II mycobacterium. Eight in volved patients with bronchiectasia (5 cases), diabetes mellitus (2 cases), or leukaemia (one case). Haemophilus influenzae, Pseudomonas aeruginosa, and Moraxella catarrhalisat more than 107 CFU per ml of sputum were isolated from 6 patients diagnosed with MAC or M. kansasii lung diseases, suggesting the possibility of mixed infections.
M. tuberculosis and atypical mycobacterium (15 cases), and two different atypical mycobacteria (16 cases) were isolated from the same or different specimens of the same patients at the same or different times. However, the pathogenicity of these mycobacteria remained unknown, because atypical mycobacteria are non-pathogenic in many cases.
The above findings suggested that the environment fit for the mycobacteria growth in human body has gradually been formed associating with aging, lung-lesion, and decline of immune capacity.

抄録全体を表示

The patient was 71-year-old male with a history of sinobronchial syndrome since 8 years ago. He has been suffering from cough, sputum and upper abdominal discomfort since January 1994. He was diagnosed as an early gastric cancer by endoscopy, and his chest X-ray film showed an infiltrative shadow in the right upper lung field. A smear of the sputum specimen was positive for acid fast bacilli, which were later identified as Mycobacterium intracellulare.
In this case, before the Mycobacterium intracellulare infection, it was confirmed that his mucociliary transport was severely impaired by using aerosol inhalation cinescintigraphy. This case suggests that an impairment of the local defence mechanisms may play an important role in the pathogenesis of Mycobacterium intracellulare infection.

抄録全体を表示

We evaluated the anti-Mycobacterium avium complex (MAC) activities of KRM-1648 (KRM), clarithromycin (CAM) and levofloxacin (LVFX) in 7HSF medium at concentrations in human blood after their oral administration of clinical dosages. MAC organisms were inoculated into tubes containing the medium with or without the addition of test drugs at either 1/10 Cmax, Cmax or C_{0- 8h} (average concentrations during the first 8 h) in the blood. KRM at Cmax or C_{0- 8h} showed strong bactericidal activity against MAC, CAM showed weak or moderate degree of bactericidal activity at Cmax and C_{0- 8h}, while LVFX added at Cmax or C_{0- 8h} showed only a weak bacteriostatic effect against M. avium, but did not show any effect against M. intracellulare.

抄録全体を表示