[Treatment of non-tuberculous pulmonary mycobacteriosis]

Mitsunori Sakatani, Yoshiki Nakajima
Kekkaku: [Tuberculosis] 2006, 81 (1): 35-50
The non-tuberculous mycobacteriosis (NTM) is not a unitary disease. It is a general term for the bronchopulmonary diseases caused by any mycobacterium other than M. tuberculosis. We don't call the pulmonary "pseudomoniosis" for the diffuse bronchiectasis caused by Pseudomonas aeruginosa, though conditions of the disease looks like NTM. The name of NTM represents that the causativebacteria belong to the same species with M. tuberculosis which causes serious pulmonary infectious disease. The pulmonary diseases caused by M. kansasii or M. szulgai are usually treated by RFP, EB and INH, the same regimens with tuberculosis, which generally lead to sufficient results for patients. But for MAC diseases, the number of patients is top of NTM in Japan, recent treatment with new-macrolides and some anti-tuberculous drugs generally does not bring about the desired effect. The plenty clinical experiences for NTM in HIV positive patients have lead to such new regemens in the USA. For NTM caused by rare Mycobacterium detectedvery seldom, clinical experiences and knowledge are definitely insufficient. (1) Present state of therapy for pulmonary MAC disease (drug therapy): Yoshihiro KOBASHI (Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama Prefecture) Co-operative study of Research Committee of Mycobacterium in the Chugoku and Shikoku areas revealed that the combined therapy according to the guidline is clinically appropriate for pulmonary Mycobacterium avium complex (MAC) disease. (2) Relapse and chemotherapy duration of pulmonary Mycobacterium avium complex infection: Atsuyuki KURASHIMA (Division of Clinical Research, National Organization Tokyo National Hospital, Kiyose, Tokyo) Reviewing the 71 relapses out of 1170 pulmonary MAC infection cases, he indicated that 11.3% relapsed during the chemotherapy continuation, 23.9% after the reduction of chemotherapy, 64.8% after the termination of chemotherapy. In the last group, there is no correlation to the relapse period after the end of treatment with the preceding chemotherapy duration. It is supposed that the main cause of these relapses are enviromental re-infection. (3) Chemotherapy for pulmonary M. kansasii disease: Katsuhiro SUZUKI (Clinical Research Center, Nationl Organization Kinki-chuo Chest Medical Center, Sakai, Osaka) Analysis of 938 pulmonary mycobacteriosis in 2003 revealed that 244 (26%) patients suffered from NTM, in which 66 (27% of NTM) were M. kansasii disease. The 48 (73%) patients were male. From 2001 to 2004, in the 190 M. kansasii patients treated by anti-tuberculous drugs, H/R/E prescribed for 84 cases (44%), other 41% of prescriptions included CAM and (or) LVFX. Almost all patients were converted into bacilli negative in about 30 days with any prescription. (4) Treatment and management for NTM patients in aprivate clinic: Seiji MIZUTANI (Mizutani Respiratory Clinic, Nerima ward, Tokyo) Analysing clinical experiences, he emphasized that most NTM patients with some symptoms visits private clinics in the first place. In Japan, diagnosis of NTM with radiological and bacteriological examinations is not difficult, and most NTM patients can be controlled as the outpatients of the clinics. (5) Surgical Treatment for non-tuberculous mycobacteriosis: Kouji KIKUCHI (Division of Chest Surgery, Medical Center, Saitama Medical School, Iruma county, Saitama Prefecture) The 9 NTM cases surgically treated were analysed, 8 were MAC cases and 1 was M. kansasii case. The main reasons for sugical resection were, continuous hemoptisis, continuous productive cough, or exacerbation on chest X-ray features. The NTM bacilli were positive in 8 cases, another one was bacilli negative, though X-ray shadows increased. After the surgery, expectoration of bacilli converted to negative in 5 SPECIAL COMMENTARIES: Can pneumonectomy be an acceptable procedure for non-tuberculous mycobacterial infection?: Yuji SHIRAISHI (Division of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo) The 11 NTM patients were analysed, who underewent pneumonectomy. The median blood loss was 555 ml and there was no operative mortality. Bronchpleural fistula or empyema occured in 4 patients. The bacilli negative conditions were achieved in all patients after surgery. The NTM is not a legal epidemic disease and Japanese Tuberculosis Prevention Act doesn't cover this disease. The medical treatment insurance system doesn't contain the NTM in the list of applicable diseases in Japan. Though these some problems with increasing numbers of patients remain in clinical practice, chairpersons hope that this symposium will be a milestone for the generalized progress of treatment and management of NTM in Japan.

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