This study was done on the back ground factors of patients, from whom a “Mycobacterium” rhodochrous-like organism, Gordona bronchialis, in their sputum was isolated. A considerable number of patients ...had received surgical treatment, thoracoplasty or lobectomy, and usually showed cavities. All patients seemed to have bronchiectasis and/or chronic cavities. The two organisms, Gordona terrae and Gordona rubra, that were considered to belong to the same genus together with G. bronchialis, were isolated from the soil, but G. bronchialis was not yet isolated from the soil. G. bronchialis was considered to be an organism that shows specific affinity to human. It was observed that two patients frequently showed this organism in their sputum. This finding suggests that G. bronchialis is able to multiply in a bronchial tract or in cavities. In conclusion, G. bronchialis is suggested to be an organism that is able to survive in a respiratory tract, in presence of bronchiectasis and cavities which are possibly favourable for the survival of the organism.
1. Of 2, 781 patients newly admitted in the year 1984 to the mycobacteriosis departments of the participating hospitals, 129 patients (4.6%) had lung infection due to nontuberculous mycobacteria. The ...prevalence rate of the lung disease due to non-tuberculous mycobacteria in the year 1984 was estimated as 2.13 per 105 population per year, and the prevalence rates of the M. kansasii disease and of the M. avium complex disease as 0.44 and 1.58 per 105 population, respectively (Table 1 and 9). The prevalence rate of non-tuberculous mycobacteriosis was higher in the prefectures of Aichi, Osaka, Tokushima and Kochi which are in the South-West coast of the Pacific Ocean (Fig. 1 and Table 1). 2. The kind of the species of mycobacteria that caused lung infection in newly admitted patients are shown in Table 2. Seven species appeared as causative organisms. 3. The species of mycobacteria that caused lung infection in patients who were admitted in the preceding years and stayed in the year 1984 in the participating hospitals are shown in Table 4. When compared with the species that caused disease in newly admitted patients, the ratios of the species M. avium complex and M. fortuitum were higher in the patients who stayed from the preceding years. The fact suggests that the disease due to these species are difficult to cure. 4. The bed occupation rate of patients with non-tuberculous mycobacteriosis was determined as 10.2% (Table 5). The rate is almost similar to the rate in the year 1983, although the rate has inoreased continuously from the year 1971 (0.9%) to the year 1983 (9.7%). 5. The sex and the age of patients with non-tuberculous mycobacteriosis are shown in Table 6. 6. The frequency of isolation of non-tuberGulous mycobacteria from sputum specimens of hospitalized patients by monthly sputum examination was estimated as 18.1% (Table 7). This value was the highest since 1971
Nine cases (8 pulmonary disease and I pleural empyema) of the respiratory disease due to Mycobacterium fortuitum were found in 5 of 13 National sanatoria in Japan during the period from January 1967 ...to August 1980. It was supposed that the respiratory disease due to M. fortuitum occupied about 1 per cent of whole atypical mycobacteriosis and the patients were found all over the country. The patients previously reported in Japan were all over 40-year-old and the patients found in National sanatoria were all over 50-year-old, while patients under 20 years of age have been found not rarely in Europe and America. There were no difierence in the number of patient by sex (5 men and 4 women). Subjective symptoms such as fever, cough, sputum and hemoptysis were observed at the onset of the illness in the majority of the patients. The disease was divided into two types; i.e., the primary infection type without underlying respiratory disease and the secondary infection type with preexisting disease. Three of 9 cases belong to the primary infection type. In the remaining 6 cases which belong to the secondary infection type, plumonary tuberculosis, pleurisy and pneumoconiosis was observed as the underlying disease, but there was no association of achalasia which was found frequently in European and American patients. In the primary infection type sputum culture negative conversion occurred in all cases by antituberculous drug therapy alone and the appearance of their chest X-ray improved, although all strains isolated from the patient were completely resistant to all antituberculous drugs. On the contrary, in the majority of the secondary infection cases the excretion of organisms from sputum continued for extended periods. No patient underwent any surgical treatment. Two patients have died during this period, but both patients died of the disease other than atypical mycobacteriosis.
From data obtained in 1980, the incidence rate of the lung disease due to atypical mycobacteria in Japan was estimated as 1.5 per 105 population per year. The incidence rate during the period from ...1976 to 1980 ranged from 1.3 to 1.9 per 105 population per year, and the rate seemed almost constant. When observed on individual diseases, however, the incidence rate of the lung disease due to M. avium-M. intracellulare, which occupies a majority of all atypical mycobacteriosis, ranged from 1.2 to 1.7 per 105 population per year and seemed to be almost constant, whereas the prevalence rate of the lung disease due to M. kansasii increased from 0.04-0.1 in 1975-1976 to 0.25 in 1980. In accordance with the increase of the incidence rate of the M. kansasii disease, the location where the disease was found has spread from Tokyo area to several prefectures, Osaka, Fukuoka, Shizuoka and Kochi. To explain this phenomenon, a hypothesis has been presented that the increase of the incidence correlates to decrease of tuberculosis. In a circumstance where the prevalence of tuberculosis is still high, persons with attenuated resistance may be infected by tubercle bacilli and develop tuberculosis, but in a cir cumstance where the prevalence of tuberculosis is low, such persons may become infected by M. kansasii which originates from the environment. In the past one decade, 35, 696 patients were hospitalized to our tuberculosis departments. Out of these patients, 632 (1.8%) of the patients with atypical mycobacteriosis were found; M. kansasii disease, 59 (9.3%); M. szulgai disease, 3 (0.5%); M. avium-M. intracellulare disease, 558 (88.3%); M. fortuitum disease, 7 (1.1%); M. chelonei disease, 3 (0.5%); others, 2 (0.3%).
STUDIES ON THE LUNG DISEASE DUE TO TSUKAMURA, Michio; KITA, Nobuhiko; SHIMOIDE, Hisao ...
Kekkaku,
1984/05/15, Letnik:
59, Številka:
5
Journal Article
Odprti dostop
1) In the period of one year from the 1st January 1982 to the 31st December 1982, 3, 257 patients with mycobacterial lung disease were admitted to tuberculosis departments of participating hospitals. ...Of these, 111 were those with non-tuberculous lung mycobacteriosis. The kind of species which caused infection in these patients are shown in Table 1. The ratio of patients with non-tuberculous lung mycobacteriosis against the total number of patients including tuberculosis was 3.4%. From this ratio and the prevalence rate of active lung tuberculosis in 1982, 48.5 per 105 population, the prevalence rate of non-tuberculous lung mycobacteriosis was estimated as 1.65 per 105 population. 2) The prevalence rate of active lung tuberculosis is continuously decreasing from the year 1971 to the year 1982. In contrast, the prevalence rate of non-tuberculous lung mycobacteriosis is almost constant, 1 to 2 per 105 population during the same period (Table 2 and Fig.1). 3) The ratio of non-tuberculous lung mycobacteriosis in the total numberof hospitalized patients with lung disease is contiuously increasing (Table4). 4) The kind of causative organisms and the epidemiology of non-tuberculous lung mycobacteriosis have changed in this recent decade. In the period of 1971 to 1977, the kind of species that caused lung disease were almost the same and ca. 6% belonged to M. kansasii and 90% belonged to M. avium-M. intracellulare complex. From the year 1978, the disease due to M. kansasii has increased, and the area where the disease occurs has spread from the Tokyo-Kanagawa area to all West Japan. From the year 1981, various species have appeared to cause the lung disease. In the year 1982, too, seven species have appeared as causative organisms (Table2). Now, we are probably in the days of mycobacteriosis caused by various species of organisms.
Screening for atypical mycobacteria (mycobacteria other than tubercle bacilli) were carried out in thirteen participating hospitals by using the p-nitrobenzoic acid-Ogawa egg medium. The subjects ...were the patients who were under hospitalization in June, September and December, 1975 and March, 1976. The isolation of mycobacteria was carried out using Ogawa egg medium which was inoculated with a sputum specimen after treatment with equal volume of a 4% (2%) NaOH solution for 15 minutes. 1. The ratio of atypical mycobacteria (including Gordona) among all mycobacteria was 7.8% in average and the ratio in senso stricto (excluding Gordona) was 7.5% in average (Table 1). The ratio was high in the hospitals located in South coast of Honshu and Shikoku islands facing Pacific Ocean (Fig. 1). 2. The kinds of species of atypical mycobacteria are shown in Table 2. The results agreed well with the results obtained by previous two studies (National Chest Hospital Group: Kekkaku, 48: 203-211, 1973; 51: 99-107, 1976). 3. The number of patients with lung disease due to atypical mycobacteria who were hospitalized in the period April, 1975 to March, 1976 was 128. Out of these, ca. 94% of the patients belonged to the disease due to M. avium-intracellulare omplex, and only 3% to that due to M. kansasii. Two cases showed the disease due to M fortuitum (Table 3). The frequency of occurrence of disease, so far observed using a ratio, the number of patients with disease due to atypical mycobacteria per the number of patients with lung disease (including tuberculosis) under hospitalization per day, as an index, was high in the hospitals located in the South coast of Honshu and Shikoku islands facing Pacific Ocean (Table 4 and Fig. 2). 4. The kinds of species isolated from sputa of patients with cavitary lung disease (mostly tuberculosis) and/or bronchiectasis were almost the same in three studies (Table 5). However, decrease in the ratio of M. nonchromogenicum was observed (1968 7.5%, 1971 4.4%, 1974 2.3%, t975 0.4%). 5. The kinds of species that caused lung disease were almost similar in our three studies (Table 6). Disease due to M. aviwn-intracellulare complex showed 94 to 96% of all atypical mycobacterioses, and disease due to M. kansasii 2 to 4% (Table 6). So far observed from the index used, the ratio of patients with lung disease due to atypical mycobacteria is increasing (Table 6). This increase has been suggested to be due to accumulation of such patients, as our another study (Kekkaku, 51: 447-451, 1976) showed that the prevalence rate of the disease among newly hospitalized patients was almost the same in recent five years (1971 to 1975).
The isolation rate of atypical mycobacteria (mycobacteria other than tubercle bacilli) and their kinds of species were studied in twelve participating hospitals located in various places of Japan ...during 5 years (1971 to 1975). The subject of the study was patients hospitalized in these hospitals during screening-months, June, September, December and March, of every year. The isolation rate (ratio of the number of atypical mycobacterial strains per the number of all mycobacterial strains) was significantly higher in four hospitals (Tokyo, Tenryuso, Chubu and Kinki) locating in Tokyo, Shizuoka, Aichi and Osaka Prefectures, respectively (refer to Fig.1), than the average (6.2%), and the rates in these hospitals were about 8%. Three hospitals, Kanagawa, Tochigi and Nagasaki, showed the rates of about 5%, three hospitals, Miyagi, Niigata and Fukuoka, showed the rates of 2 to 3%, and two hospitals, Sapporo and Ehime only 0.7 to 0.8% (Table 1). Distribution of the kind of species in various hospitals did not differ significantly from each other, except for a few cases. (1) The ratio of M. kansasii in Tokyo and Kanagawa Hospitals was significantly higher than the others. (2) The ratio of M. fortuitum in Fukuoka Hospital was significantly higher than the average. (3) The ratio of M. gordonae was significantly higher in Kanagawa Hospital than the average in all hospitals. The ratios of species of 950 strains of atypical mycobacteria are shown in Table 2.
