To clarify clinico-pathological features of tuberculosis found at autopsy.
This study investigates 18 (3.7%) of active pulmonary tuberculosis out of 489 autopsy in Tachikawa Sougo Hospital during the ...period from 1992 to 2005.
There were 11 men and 7 women, with a median age of 69.5 years. Tubercle bacilli were proved from sputum in 6, which consisted of 3 with positivity on sputum smear microscopy and culture, and 3 with positivity only on sputum culture. Two were examined, but not diagnosed before death. Three didn't show any positive result despite of repeated sputum tests. The features of the chest radiological findings were: (1) Shadows that present prior tuberculosis (ex: nodules, fibrotic lesion) were found in 9 and ground-glass-opacity in 5. (2) In 6, radiological findings consistent with tuberculosis were not pointed out because shadows such as fibrosis, pleural effusion, or cancer were mixed in the same lung. (3) In 11, main radiological findings were found in atypical segments, when there were some underlying conditions such as the use of corticosteroidal therapy or diabetes mellitus. Four were diagnosed correctly, and treated with anti-tuberculosis drugs. Other 14 were not diagnosed before death and diagnosed wrongly as pneumonia, cancer, or other diseases. Encapsulated caseous nodules were seen in 7, and autopsy confirmed that 12 including these 7 were caused by endogenous reactivation. Miliary tuberculosis was found in 5, caseous pneumonia/bronchitis in 6. One had tuberculous empyema. As to underlying diseases, 8 had malignant disease, 6 had diabetes mellitus and 6 were treated with corticosteroids.
This study suggests that sputum culture or radiological findings are not sufficient enough to diagnose tuberculosis, especially in compromised host. We emphasize the vital role of treatment for latent tuberculosis for cases with high risk of endogenous reactivation, and it's necessary to make the guideline for the treatment of such latent tuberculosis.
A nationwide study was conducted to investigate the efficacy of Clarithromycin (CAM) on pulmonary atypical mycobacteriosis caused by the Mycobacterium avium-Mycobacterium intracellulare complex, ...including intractable cases. Out of total 97 patients examined, the analysis for bacteriological efficacy was possible in 69 cases. The negative conversion of bacilli was observed in 18 cases (26.1%), and 5 out of 12 cases in which the follow-up was conducted turned out continued negative status. The efficacy of CAM was relatively high in the following cases: the duration of the disease was less than 6 months; the extent of pulmonary lesions on chest roentogenograms was limited or moderate; and antituberculous agents which were previously unused were applied in combination with CAM. Also, the efficacy was high in cases where the dose of CAM was 600 mg/day or higher. Major side effect was mild to moderate digestive symptoms. In conclusion, at daily dose of 600 mg or higher, CAM was effective in the elimination or reduction of M. avium-M. intracellulare complex that caused atypical mycobacteriosis, without developing serious side effect. Treatment with this drug should be attempted in intractable cases.
We conducted a survey on nontuberculous mycobacteria (NTM) isolated in association with colonoscopy at two hospitals. NTM was isolated from the fluid-phase of colonic contents in 17.6% of the ...specimens obtained at hospital A and in 46.3% at hospital B. The rate of isolation from the preexamination suction fluid was 9.5% and 43.3% at hospital A and B, respectively. Tap water samples from both hospitals were examined and proved to be free from contamination with NTM. The mycobacterial species isolated at hospital A were M. chelonae subsp. abscessus, M. chelonae subsp. chelonae, M. fortuitum, and M. gordonae. M. chelonae subsp. abscessus was the only mycobacterial species isolated at hospital B. M. avium complex was not isolated at either hospital. By an additional procedure to cleans and decontamitate the endoscopes by suction with Maskin ethanol solution, the incidence of isolation of NTM from the fluid-phase of colonic contents was significantly reduced. None of the patients from whom NTM was isolated exhibited positive signs of colonic NTM infection by the endoscopic examination and none had anyunderlying diseases which might induce immune suppresion. We suspect that most of the NTM isolates have originated from the contaminated endoscope. In conclusion, when a colonoscopic examination is carried out in suspicion of NTM disease in intestine, it is essential to reassess the possibility of mycobacterial contamination of the colonoscopes and implement appropriate steps for cleansing and sterilization of them.
A case of lung infection caused by an unusual strain of Nocardia farcinica is reported. This is the third case of the N. farcinica infection in this country. The strain failed to utilize rhamnose as ...sole carbon source, but could be identified by a numerical identification method. The mycolic acids contained 1-3 double bonds and the numbers of the carbon atoms of the mycolic acids were 50 to 60, average 56.
Fifty patients with extrapulmonary tuberculosis were diagnosed at 4 community hospitals in Tokyo during 1981 to 1992. The percentage of extrapulmonary tuberculosis among the all types of tuberculosis ...was 10.5 % as a whole, and 16 % in females and 7.9 % in males. The number of patients older than fifth generation was about two times more than that of younger generations. And the patients were more in males than in females under the forties, but were more in females than in males over the sixties. On chest radiogram, there was no pathological findings in 52 % of the patients and active pulmonary tuberculosis was detected in 32 % of the patients. The majority of the extrapulmonary tuberculosis (30 cases, 60%) was of lymph nodes, especially of cervical lymph nodes, and the remainings were 10 cases of tuberculosis in bone and joint, 4 each in intestine and pericardium, 2 each in liver, peritoneum, kidney, urinary bladder, epididymis and skin. Among 30 cases with tuberculous lymphadenopathy, the disease were observed in cervical lymph nodes by 19 cases, in pulmonary hilar and axillary node by each 4 cases and in abdominal cavity by 3 cases. The majority of the patients with lymphadenopathy was under the forties in males (78.6%) but, on the contrary, above the fifties in females (75%). Most of the patients with superficial lymphadenitis were diagnosed by the histological examination of tissue specimens obtained by biopsy. Cervical lymphadenitis was diagnosed histologically in 76.5% of the cases and bacteriologically in 52.9 %of the cases. As for the lymphadenitis in the depths, computed tomogram, ultrasonic echogram, pathological and bacteriological examinations of specimens obtained by surgical procedure gave the clue for diagnosis.
In numerical classification, four species of the Mycobacterium nonchromogenicum complex, Mycobacterium nonchromogenicum, M. terrae, M. novum, and M. triviale, formed one cluster. These four species ...appeared to be reduced to one species, Mycobacterium nonchromogenicum. Furthermore, relationships between the species were numerically analyzed by using the hypothetical median organism pattern. The results showed that the M. nonchromogenicum complex can be divided into two subgroups: M. nonchromogenicum and the other three. These two subgroups were differentiated from each other by scores based on two or more positive reactions in the following three characteristics: resistance to bleomycin (5 μg/ml); heat‐stable acid phosphatase activity; nicotinamidase or pyrazinamidase activity or both activities. M. nonchromogenicum gave two or three positive reactions among these three, and M. terrae, M. novum, and M. triviale gave two or three negative reactions.
Three cases of lung infection due to M. nonchromogenicum, as well as three other cases of probable lung infection due to M. nonchromogenicum, were observed in this study. Only one organism isolated from one doubtful case was M. terrae. Up to now, M. nonchromogenicum was considered a nonpathogen. It was shown, however, that this organism causes lung infection in humans.
Among the outpatients of a certain hospital in Tokyo, mycobacterium tuberculosis colonies fewer than ten were isolated sporadically from single sputum specimens from 3 patients with non tuberculous ...pulmonary disease and 6 patients with inactive pulmonary tuberculosis, and sputum culture thereafter were contineously negative for a long period. The majority of such few colony isolates were found on days when the sputum specimens from the patients with smear positive tuberculosis or the specimens from which a large number of colonies were isolated, were cultured. The frequency of these few colony isolates was investigated. It was higher on days when smear positive specimens were cultured than on other days. From the results mentioned above, it is suggested that there is a possibility of cross contamination between smear positive sputum specimen and culture negative specimen. However, when a few colony is isolated from a single specimen, rare cases of pulmonary tuberculosis with normal chest radiographs should not be disregarded.
During the period from 1960 through Octover 1976, Mycobacterium kansasii was isolated from 72 patients in Japan. 1) Sixty-seven patients were found to have parenchymal pulmonary disease due to this ...organism. Besides these cases, there were one patient with pleurisy and another with lupus dis seminatus miliaris faciae. 2) In only 3 cases, the organism was isolated as saprophyte and showed no relation to active pulmonary disease (colonization). The patients with colonization were very rare in Japan up to the present. 3) Fifty-eight patients (80.6%) were living in Tokyo and its vicinity, and only a few patients were found in other districts. Therefore, it is suggested that the incidence of the infec tion with M. kansasii is different geographycally in Japan. 4) The majority (94.1%) of the disease occurred in men. The majority of the patients infected with M. intracellulare were in middle age and over and had some underlying lung diseases, while many patients infected with M. kansasii were found among younger personswithout any previous lung disease. 5) On the chest radiogram of 64 pulmonary cases, cavitation was found in 55 cases (85.9%). The cavity was thin-walled and not rarely multiple, and was found more frequently in the mid lung than in the subpleural region. The lesions were found more frequently (3.4 times) in the right lung than in the left lung 6) The sensitivity to rifampicin (RFP) (91.7% of the tested strain), ethionamide (TH) (90.2%), and cycloserine (CS) (94%) was a characteristic feature of the drug susceptibility of M. kansasii. Many strains were susceptible to viomycin (VM) (70.2%), capreomycin (CPM) (69.0%) and ethambutol (EB) (57.1%) and showed low grade resistance to isoniazid (INH) and EB. 7) SM, PAS and INH was used most frequently. RFP, TH and CS was used in 48.4%, 35.9% and 32.8% of the patients respectively. Bacteriological conversion occurred in 54 patients (84.4%) by chemotherapy alone, and comparing by the regimen, the negative conversion occurred in 5 patients (55.6%) by the combination of SM, INH and PAS, in 11 patients (78.6%) by the chemotherapy including secondery drugs (EB, CS, VM, etc.) except RFP and TH, in 11 patients (91.7%) treated with the regimen containig TH, in 18 patients (94.7%) treated with the regimen containing RFP, and in 9 patients (100%) treated with the regimen containing both TH and RFP. By the chemotherapy excluding RFP and TH, less satisfactory results were obtained especially in the far advanced cases. 8) Four patients received combined medical-surgical treatment (1 segmentectomy, 3 lobec tomy), and no complication was found. 9) During the study period, 4 of 68 patients died, with 2 deaths attributed to M. kansasii infection, and the remaining 2 not attributed to M. kansasii infection.
Mycobacterium szulgai (1) is a new species recently described. It belongs to slowly growing scotochromogens (Runyon's Group II (2)). Recently we isolated three strains of mycobacteria from sputum ...specimens of a patient, a 50 year-old male carpenter. The strains were isolated on the 23rd, 24th and 25th of June 1976 and formed 86, 44 and 4 colonies, respectively, on isolation media. At that time, the chest X-ray film of the patient showed a large cavity with pericavitary infiltration in his left upper lobe. After six-month-administration of a streptomycin-isoniazidrifampicin regimen, the cavity became thin-walled and the organism disappeared from sputum. In view of the above course of the disease, the organism was considered to have caused the disease in the patient. The strains were examined according to the methods previously described (4) and identified as M. szulgai (Table 1). The strains used in the study were isolated from single colonies. The most interesting characteristic of the strains was their temperature-dependent photochromogenicity. The strains were nonchromogenic when incubated on Ogawa egg medium at 28 C in the dark for 14 days, whereas the colonies became scotochromogenic (orange-pigmented) when incubated at 37 C in the dark. The colonies that grew at 28 C in the dark became pigmented after exposure to daylight for one day. Temperature-dependent photochromogenicity of M. szulgai in several strains was reported by Schaefer et al (3). The findings in the present study show that such strains occur and lung disease due to this organism is also present in this country.
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