Pulmonary Mycobacterium Avium Complex Research Articles

Clinical Analysis of Pulmonary Nontuberculous Mycobacterial Disease Diagnosed as Coincidental Pulmonary Infection Due to <i>Mycobacterium</i> Species*

Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixty patients satisfied the diagnostic criteria of nontuberculous mycobacterial disease proposed by American Thoracic Society during the last seven years. Six patients (3.8%) were coincidental pulmonary infection due to two Mycobacterium species. We investigated the background, laboratory findings, microbiological findings, radiological findings, treatment and prognosis. Results: There were six patients, 3 males and 3 females, with a mean age of 71.7 years. The causative microorganisms of coincidental pulmonary infection consisted of Mycobacterium avium + Mycobacterium intracellulare in two patients, Mycobacterium avium + Mycobacterium kansasii in one, Mycobacterium intracellulare + Mycobacterium chelonae in one, Mycobacterium intracellulare + Mycobacterium abscessus in one, and Mycobacterium intracellulare + Mycobacterium tuberculosis in one. Regarding the radiological findings, the distribution of the lesion was frequently shown in both the right middle and left lingula lobes, but the extent of the lesion was limited within the unilateral lung field. Centrilobular small nodules with bronchiectasis were recognized in all patients and cavities or infiltration shadows were recognized in half of them on chest computed tomography. A definite diagnosis was obtained by bronchoalveolar lavage fluid in four patients and expectorated sputum in two. Combined chemotherapy was performed for two patients and that for pulmonary tuberculosis in one. Conclusions: Coincidental pulmonary infection due to Mycobactterium species occurred at a low percentage. Although most patients were elderly with underlying disease and clinical features were compatible with pulmonary Mycobacterium avium complex disease, the prognosis was comparatively good with and without treatment.

Clinical characteristics and prevalence of pneumothorax in patients with pulmonary Mycobacterium avium complex disease

Pneumothorax in patients with pulmonary Mycobacterium avium complex (MAC) disease is considered to be a rare complication, and little is known about its clinical course. In this study, we aimed to define the clinical features, outcome, and prevalence of pneumothorax in patients with pulmonary MAC disease. A retrospective review of medical records identified eight men and ten women (mean age, 75years) with active pulmonary MAC disease complicated by pneumothorax between 2003 and 2010 in our institution. None of the patients was positive for HIV infection. Pneumothorax occurred in the right lung in 12 patients and in the left in six. All but one patient had MAC disease in both lungs, and 12 patients had widespread lesions covering a total area larger than one lung field. Seven of the 18 patients (39%) were forced to undergo surgery following unsuccessful thoracic drainage. Five patients experienced recurrence during the study period and two others eventually developed chronic pneumothorax. The complication rate of pneumothorax was calculated on the bases of the total number of patients with active pulmonary MAC disease during the same period. The overall complication rate of pneumothorax was as high as 2.4% (18 of 746 patients with MAC disease). In conclusion, the incidence of pneumothorax in patients with active pulmonary MAC disease was unexpectedly high, especially in patients who were elderly and had advanced MAC disease. This condition is often difficult to treat and can recur easily.

Association of SLC11A1 (NRAMP1) polymorphisms with pulmonary Mycobacterium avium complex infection

Although genetic variants in SLC11A1 (NRAMP1) have been associated with mycobacterial diseases, these findings have not been extensively validated in pulmonary Mycobacterium avium complex (MAC) infection. This study investigated the genomic structure of SLC11A1 and its association with MAC infection. Nineteen polymorphic loci were genotyped in European descendents and the Japanese population. Linkage disequilibrium (LD) structures and frequencies of major haplotypes differed between these 2 populations. Tag single nucleotide polymorphisms (SNPs) were chosen from the data set, and 6 polymorphic sites were genotyped in 122 pulmonary MAC cases and 211 controls from Japan. We observed that the T allele of rs2279014 in the 3' untranslated region was associated with protection from MAC disease when comparing allele frequencies with an odds ratio of 0.582 (95% confidence interval 0.379-0.894, p = 0.013). The frequencies of haplotypes constructed with the above 6 variants did not differ between cases and controls. Allele-specific expression imbalance of SLC11A1 mRNA was evaluated in peripheral blood cells from heterozygous individuals, but no difference was observed among haplotypes. Although the significance was modest, rs2279014 is in strong LD with nearby SNPs and further studies are required for conclusive validation.

Aging, COPD, and Other Risk Factors Do Not Explain the Increased Prevalence of Pulmonary Mycobacterium avium Complex in Ontario

The cause of observed increases in pulmonary Mycobacterium avium complex (pMAC) isolation and disease is unexplained. To explore possible causes of the increase in pMAC isolation and disease prevalence in Ontario, Canada, we studied age and other population-level risk factors. We determined age and sex of patients with pMAC disease between 2003 and 2008. We then estimated whether the potential effect of population aging and changes in prevalence of HIV infection, solid organ transplant, COPD, and tumor necrosis factor-α (TNF-α) inhibition have contributed to the observed increase in pMAC disease. During 2003 to 2008, pMAC isolation and disease prevalence (per 100,000) both increased (8.44 to 12.62 and 4.35 to 6.81, respectively). The total number of cases of disease increased by 348 (2.46 per 100,000). Based on actual contemporary population changes, aging could explain 70 additional cases (increase of 0.57 per 100,000). The increase in self-reported COPD prevalence could potentially explain 11 (95% CI, 0-42) additional cases (increase of 0.09 per 100,000 [95% CI, 0-0.34 per 100,000]). HIV infection, solid organ transplant, and TNF-α inhibition combined could potentially explain no more than 73 additional cases (increase of 0.60 per 100,000). Although population aging appears to be a major risk factor, the increase in pMAC disease in Ontario could be only partly explained by aging, increases in COPD, HIV, solid organ transplantation, and TNF-α inhibition therapy. The increase in pMAC is likely multifactorial and may be affected by environmental or pathogen factors not addressed in this study.

The clinical efficacy and safety of a fluoroquinolone-containing regimen for pulmonary MAC disease

Despite recent advances in chemotherapy, the treatment of pulmonary Mycobacterium avium complex (MAC) disease remains unsatisfactory. Judging from its MIC, fluoroquinolones including gatifloxacin (GFLX) are expected to demonstrate efficacy against MAC disease. However, there have been few clinical studies using fluoroquinolones. Therefore, a prospective study to evaluate the clinical efficacy and safety of a fluoroquinolone-containing regimen for the treatment of pulmonary MAC disease was conducted. In this trial, patients with pulmonary MAC disease received protocol-guided combined chemotherapy with rifampin (RFP) and ethambutol (EB) plus either GFLX or clarithromycin (CAM). Adult patients who fulfilled the criteria of the ATS definition of pulmonary MAC disease were enrolled in this study. The patients provided their informed consent, and treatments were administered for 1 year. Of 27 patients enrolled from three facilities, 14 patients were treated with the CAM-containing regimen and 13 patients were treated with the GFLX-containing regime. Four patients did not complete the 1-year treatment because of adverse events. Nine patients (64.3%) in the CAM group and 11 patients (84.6%) in the GFLX group achieved eradication of pathogens. Adverse events were observed more frequently in the GFLX group than in the CAM group. However, there were no severe adverse events in either group. The long-term results showed a similar relapse rate between the CAM and GFLX groups. The fluoroquinolone-containing regimen demonstrated both high efficacy and relative safety for pulmonary MAC disease that was similar to that of the CAM-containing regimen, which is considered to be the standard regimen.

Relationship between clinical efficacy for pulmonary MAC and drug-sensitivity test for isolated MAC in a recent 6-year period

There are a few recent reports about the relationship between the clinical effect and drug-sensitivity test. We investigated the relationship between the clinical efficacy of treatment for pulmonary Mycobacterium avium complex (MAC) and drug-sensitivity test for isolated MAC by comparison between data from 2005 to 2007 and from 2008 to 2010. We studied 60 patients who satisfied diagnostic criteria of nontuberculous mycobacterial infection established by the American Thoracic Society in 2007 and who received combination therapy using rifampicin (RFP), ethambutol (EB), streptomycin (SM), and clarithromycin (CAM). Average CAM dosage was increased from the early (517 mg/day) to the later (800 mg/day) period. Sputum conversion rate increased from 63% in the early period to 83% in the later period. Clinical improvement also increased from 38% in the early period to 53% in the later period. The causative microorganisms isolated were M. avium in 35 patients and M. intracellulare in 25. In both periods, isolated MAC strains showed excellent minimum inhibitory concentration (MIC) for CAM. Regarding the relationship between clinical efficacy and MICs of RFP, EB, CAM, and SM, most patients with good clinical effects showed low MIC for CAM in both periods. Good clinical efficacy, including the sputum conversion rate, was obtained with an increased dose of CAM in the later period. We speculate that the increased dose of CAM influenced the good clinical effect in both periods.

Distribution of mycobacterial antigen based on differences of histological characteristics in pulmonary Mycobacterium avium infectious diseases—Consideration of the extent of surgical resection from the pathological standpoint

Quantitative assessment of mycobacterial antigens is very important to determine the surgical indication, as well as the area of resection for pulmonary Mycobacterium avium complex (MAC) infectious disease. However, at present, pathological assessment is only possible as a postoperative examination. We performed quantitative evaluation of mycobacterial antigens using lung tissues with MAC pulmonary infection obtained from surgical resection. The distribution of mycobacterial antigens was evaluated by immunohistochemical staining with monoclonal antibody for mycobacteria. In exudative reactions, many monocyte-lineage cells containing mycobacterial antigens were observed in alveoli, whereas the quantity of mycobacterial antigens was extremely decreased in proliferative reactions. Epithelioid cells or multinucleated giant cells contained mycobacterial antigens in necrotic granulomas. In solitary nodules with central necrosis, mycobacterial antigens were frequently observed, whereas they were rarely observed in solitary nodules without caseous necrosis. Mycobacterial antigens were not observed in the epithelial layer of bronchioles in any cases, although proliferative granulomas were notably observed in the developed lymphoid follicles in subepithelial lesions of bronchiole. Thus, exudative reactions or nodules with caseous necrosis indicate the possibility of numerous mycobacteria remaining in the pulmonary focus. Therefore, intraoperative histological assessment may help in the determination of the area of surgical resection. This is the first study to quantitatively evaluate mycobacterial antigens according to histological characteristics in MAC pulmonary disease.

Surviving a crisis of HIV-associated immune reconstitution syndrome

The management of life-threatening complications in HIV-associated immune reconstitution syndrome is becoming a challenging scenario in emergency practice, especially in the era of highly active antiretroviral therapy paralleled by increased worldwide incidence of HIV infection. Here, we described a 37-year-old woman with acute hypoxic respiratory failure, acute renal failure, and hypercalcemic crisis as the presenting features of HIV-associated immune reconstitution syndrome. In this patient, the restored granulomatous host response toward isolated pulmonary Mycobacterium avium complex infection led to a near-fatal catastrophe. This report reinforces the importance of introducing a rapid, systematic approach of hypercalcemia at the emergency department and the need for clinicians to maintain awareness of this distinct manifestation.

Lichen scrofulosorum caused by pulmonary Mycobacterium avium complex (MAC) infection

ejd.2011.1377 Auteur(s) : Reiko Tobita1 reiko.kikkawa@sunny.ocn.ne.jp, Yasuyuki Sumikawa1, Kaoru Imaoka1, Susumu Murata1, Itaru Dekio1, Riruke Maruyama2, Eishin Morita1 1 Department of Dermatology, Shimane University School of Medicine, 89-1 Enya-cho Izumo, Shimane 693-8501, Japan 2 Department of Organ Pathology, Shimane University School of Medicine, 89-1 Enya-cho Izumo, Shimane 693-8501, Japan Lichen scrofulosorum (LS) is a rare tuberculid that usually develops in children and young adults. It [...]

Diagnosis and treatment of pulmonary nontuberculous mycobacteriosis

Pulmonary non-tuberculous mycobacteriosis in Japan occurs more than about 5,000 cases annually. Among them, about 70% are occupied by Mycobacterium avium complex (MAC) infection. Considering the frequency and the difficulty of treatment, we discuss mainly on pulmonary MAC infection on this report. At National Tokyo hospital, secondary MAC infection after tuberculosis sequelae were 46.5% out of 170 pulmonary MAC cases since 1969 to 1985, but it decreased to 19.4% out of 268 cases since 1986 to 2000. In this same period, a type of MAC infection like middle lobe syndrome without recognizing preceding pulmonary disease, increased to 69.8% out of all pulmonary MAC cases (Fig. 1). Recently, this type of pulmonary MAC infection, which consists with scattered nodular lesion and local bronchiectasis in middle lobe or lingula, attracts attention. Why is there much frequency in women? Why does it originate from middle lobe or lingula? Although, it shows a characteristic X-ray pattern, ant it is still an interesting problem, the origin of the disease cannot be clarified. First diagnostic standard of nontuberculous mycobacteriosis in Japan was submitted in 1967, and the current diagnostic standard was made in 1985, through several times improvements. These contents are almost similar to that of American diagnostic standard in 1997, but the new revision that reflected chest CT findings and bronchoscopic sampling etc, is pressed now. In the treatment, INH or PZA, which is a key drug in tuberculous chemotherapy, is not a key drug in MAC chemotherapy. MAC chemotherapy is multidrugs combination chemotherapy including EB, CAM, RFP, and aminoglycosides. However, it is difficult to achieve complete regression with current drugs combinations, and an early surgical resection is the most effective in case of localized MAC lesion. We propose a guidance of treatment selection with age and disease severity (Table). Fig. 2 shows survival curves of 104 cases pulmonary MAC infection at National Tokyo Hospital.

Perspective of pulmonary MAC infection treatment

Chemotherapy of pulmonary MAC (Mycobacterium avium complex) infection has been almost universally agreed with the multidrugs regimen that contains Clarithromycin (CAM), Rifampin (RFP), Ethambtol (EB), and aminoglycoside in case of advanced stage. One of the reason for the multidrugs regimen which is similar to tuberculous chemotherapy is to inhibit the emersion of resistant MAC strain. The other reasons, enhancement of anti microbial activity and response to polyclonal infection are unique to the MAC chemotherapy. In the current MAC chemotherapy, both CAM and aminoglycoside are main axes because only they can suppress the growth of MAC alone respectively. Efficacy of CAM was revealed through the randomized controlled trials of disseminated MAC infection with HIV and that consequences applied to pulmonary MAC infection treatment. CAM is not effective unless exceed 2 microg/ml blood concentration. RFP decreases CAM blood concentration remarkably, but the regimens contained RFP and CAM are superior clinically to the regimens without RFP. There seemed to be unknown pharmacological mechanisms with RFP. Although the advantage of aminoglycosides is easily achieved high blood concentration, if aminoglycoside dosage is exceed 15 mg/kg, the possibility of auditory disturbance increase. About the duration of MAC chemotherapy, many guidelines recommended that one year continuation after the negative conversion of sputum culture. It is not the evidence but an expert opinion. We often experience recurrences several months later after the all drugs are ceased. The interval days to positive conversion of sputum culture from the day of completion of chemotherapy are randomly distributed with weibull's equation. It suggests that exogenous re-infection may cause the recurrence of pulmonary MAC infection as pointed out by Wallace Jr. Considering these issues, we have the conception of pulmonary MAC infection chemotherapy as follows. 1. Full dose induction chemotherapy (two years). 2. Maintenance chemotherapy (one year). 3. Preventive chemotherapy (one year). These conceptions have to be the problem validated. However, these current chemotherapies are not effective adequately, we need the combination treatment with surgical resection when indicated as a localized focus for example. Generally chemotherapy could not cured the destructed bronchial lesion due to MAC infection as like as local bronchiectasis or cavities. Consequently, the chemotherapy just after the surgical resection of destructed focus is most appropriate period.

Clinical comparison of male and female patients with pulmonary disease caused by Mycobacterium avium complex (P-MAC)

The objective of this study was to clarify clinical feature of Pulmonary Mycobacterium avium complex disease (P-MAC). The present study was performed in 120 patients with P-MAC diagnosed during the period from January 2000 to March 2007. We divided P-MAC patients into four groups by the clinical disease type and gender, and retrospectively examined the clinical characteristics. The subjects were 15 male (NB-M) and 71 female (NB-F) patients with nodular bronchiectatic disease (NB), and 24 male (FC-M) and 10 female (FC-F) patients with fibrocavitary disease (FC). The average age was lowest in the NB-F group (58.0 yrs), and highest in the FC-M group (65.8 yrs). There were 17 patients in the FC-M group and only two patients in the FC-F group with a history of smoking. The average body mass index (BMI) was 16.9, with the lowest value in the FC-F group. In the FC-M group, most of the patients had underlying pulmonary disease, whereas in the FC-F group, only four patients had underlying old pulmonary tuberculosis. The average anterior-posterior dimension was 75.2 mm, being lowest in the FC-F group, and more than 90 mm in the other groups. The proportion of refractory cases was lowest in the NB-M group. We thought that we were able to clarify characteristics of patients with disease caused by MAC by analyzing the types of the disease separately in men and women.

A study of factors relating to aggravation of patients with pulmonary Mycobacterium avium complex disease--with special reference to malnutrition

We examined physical and blood statuses of 24 patients with pulmonary M. avium complex disease who entered our hospital from April 1993 to March 1997. Ten patients (41.7%) were diagnosed as primary infection type and 14 patients (58.3%) as secondary infection type. Twenty-four patients were classified to the following two groups: Group A was 14 patients who converted to MAC negative within six months after the admission and group B was 10 patients who continued to excrete MAC for more than six months after the admission. We made a comparison between group A and group B as to the results of physical and blood examinations on admission. Mean value of %IBW in group B was significantly lower (group B:74.4 +/- 8.9%, group A:82.9 +/- 12.7%, p < 0.05) than that of group A. The level of serum albumin in group B was significantly lower (group B: 3.39 +/- 0.53 g/dl, group A: 3.99 +/- 0.45 g/dl, p < 0.01) than that of group A. ChE in group B was significantly lower (group B: 321.2 +/- 94.5 IU/l, group A: 442.9 +/- 148.4 IU/l, p < 0.05) than that of group A. Group B was nutritionally depleted than group A. In conclusion, these findings suggested that nutritional support should be taken into consideration in combination with conventional chemotherapy in treating chronic, intractable MAC disease.

Clinical analysis of drug interaction between rifampicin and clarithromycin which are used for treating pulmonary Mycobacterium avium complex infection

We reviewed the interaction between rifampicin (RFP) and clarithromycin (CAM) during treatment of pulmonary Mycobacterium avium complex infection. The subjects were patients with pulmonary non-tuberculous acid-fast bacillus infection during the period from September 2004 to January 2006 who consented to this study. Drug blood concentrations were compared with the minimum inhibitory concentrations for M. avium isolated from sputum and blood levels of CAM were assessed when the time of administration was changed for RFP. The blood concentration of CAM showed a marked decrease in all cases (n = 6) when administered together with RFP, but there was no significant difference in the blood concentration of 14-R-hydroxy-clarithromycin (M-5), the active metabolite of CAM. However, the total blood concentration of CAM and M-5 showed a significant fall, similar to the blood concentration of CAM alone. When the blood concentration and bacterial MIC were compared for RFP, the blood concentration exceeded five MIC(s) in six samples as did the CAM+M-5 level in four out of six samples. There was no significant difference in the blood concentration of CAM (n = 5) when the time of RFP administration was altered. CONCLUSION; Because the total blood concentration of CAM+M-5 fell markedly by co-administration of RFP, this might have an influence on the antibacterial effect of CAM. In addition, examination of the administration of RFP and CAM at different times showed that the blood concentration of CAM did not increase and the influence of induction of hepatic drug-metabolizing enzymes by RFP could not be avoided.

An adolescent case of pulmonary MAC infection, found 3 years later from bone marrow transplantation for myelodysplastic syndrome

Mycobacterium avium complex (MAC) pulmonary infection is usually seen in elderly persons. We encountered a rare case of MAC pulmonary disease seen in a 19-year-old adolescent. The patient had received bone marrow transplantation at the age of 16 for myelodysplastic syndrome. Subsequently, he developed constrictive bronchiolitis and has been treated with corticosteroid and taclorimus. At age 19, small or fine nodules and a cavitary nodule in right lung were detected on the chest radiograph and computed tomography. Afterwards, Mycobacterium avium was detected by bronchoscopic examination and sputum examination and he was diagnosed as MAC pulmonary infection. MAC pulmonary infection in a young person at the age of 19 is an extremely rare case, in which constrictive bronchiolitis, immunosuppression by corticosteroid and tacrolimus, and diabetes mellitus were considered as critical predisposing factors.

Bronchoscopic Microsampling for Bacterial Colony Counting in Relevant Lesions in Patients with Pulmonary Mycobacterium avium Complex Infection

The incidence of pulmonary Mycobacterium avium complex (MAC) infections with nodular/bronchiectasis lesions is increasing. However, factors determining deterioration are unknown. In the present study, we investigated quantitative MAC cultures obtained through bronchoscopic microsampling (BMS) from patients with pulmonary MAC infection and analyzed the relationship between MAC culture and the short-term natural history. We also assessed chest computed tomography (CT) findings for the deteriorating factors. For this prospective study, MAC was collected from peripheral lung lesions by BMS through endobronchial ultrasonography. MAC colonies were counted on Middlebrook 7H11 agar. We compared the number of MAC colonies with laboratory data and chest CT findings. We studied 26 patients with pulmonary MAC infection. The patients were divided into 2 groups: 11 patients in the non-deteriorated group and 15 patients in the deteriorated group. The number of MAC colonies was significantly correlated with deterioration of MAC infection (p < 0.001). In the non-deteriorated group, chest CT scans showed nodular/bronchiectasis lesions in 8 patients (73%) and consolidated lesions in 3 patients (27%). In the deteriorated group, chest CT scans showed nodular/bronchiectasis lesions in 1 patient (7%), consolidated lesions in 6 patients (40%), and cavitary lesions in 8 patients (53%). The number of MAC colonies in relevant lesions investigated by BMS was significantly larger in the deteriorated group than in the non-deteriorated group. Cavitary and consolidated lesions observed from chest CT scans are thought to indicate a high risk of progression of pulmonary MAC infection.

Nutritional Assessment in Patients with Pulmonary Nontuberculous Mycobacteriosis

To determine the nutritional factors that influence disease spread in patients with pulmonary Mycobacterium avium complex (MAC) infection. A prospective observational study. Patients with pulmonary MAC infection were enrolled in this study. Chest computed tomography (CT), abdominal CT, and physical, clinical, and nutritional laboratory data were collected after obtaining informed consent. Seventy-eight patients (16 males and 62 females) were consecutively enrolled. While the mean body mass index (BMI) was low (19.6 ± 2.7 kg/m(2)), the mean serum albumin concentration was within normal range (4.2 ± 0.2 g/dL). We evaluated the number of affected lung segments to define the degree of disease spread, and examined the relationships between various parameters and disease spread. Multivariate analysis identified the duration of the disease (+1.6 segment/100 months, p=0.03), BMI (-0.5 segment/BMI, p=0.003), and white blood cell count (+0.7 segment/1,000 WBC, p=0.03) as factors contributing to disease spread. BMI is an excellent marker for nutritional assessment and for predicting disease spread in patients with pulmonary MAC infection.

慢性肺アスペルギルス症に対するイトラコナゾール注射薬と 高用量カプセル薬による維持療法の検討

Itraconazole (ITCZ) is a novel triazole antifungal with a broad spectrum including Aspergillus species. We conducted a three-month open, noncomparative multicenter study of the efficacy and safety of ITCZ injections and high dose capsules in chronic pulmonary aspergillosis. Patients with chronic pulmonary aspergillosis received intravenous injection of ITCZ (200mg) (twice a day for the first two days, then once a day for the following 3-12 days) prior to the oral administration of ITCZ capsules (200mg) twice a day. Radiologic findings by chest CT and clinical symptoms were evaluated at baseline and 12 weeks later. We also measured ITCZ plasma trough concentrations after two weeks and four weeks of the study. Twenty patients were included in the study, among which 14 patients presented with chronic necrotizing pulmonary aspergillosis (CNPA) and 6 presented with pulmonary aspergilloma. The efficacy evaluation was available in 17 patients (CNPA, 12 patients; aspergilloma, 5 patients). Radiological improvement was observed in nine (52.9%, 95%CI: 31.0%-73.8%) patients (CNPA, 7 patients; aspergilloma, 2 patients). One patient with aspergilloma showed deterioration. The clinical symptoms showed significant improvement on expectoration, bloody sputum, and pyrexia. Two patients had to stop treatment with ITCZ because of congestive heart failure. Other adverse effects were reported but did not lead to the discontinuation of treatment, as follows: hepatic dysfunction, two patients; hypokalemia, nine patients. In two patients who combined pulmonary Mycobacterium avium complex disease coadministration of ITCZ and rifampicin was done. Their ITCZ plasma concentrations were extremely low, and one of them was the only deterioration case in the primarily radiologic evaluation. Itraconazole injections and high dose capsules maintenance therapy is effective in treating chronic pulmonary aspergillosis.

Concurrent Lung Cancer in Non-Tuberculous Mycobacteriosis: Case Report

An 82-year-old woman was admitted to our hospital after multiple round opacities were detected in chest X-rays performed during a routine health screening. Mycobacterium avium complex (MAC) was found in sputum cultures, and compatible pathological findings on biopsy confirmed pulmonary MAC infection, whereas biopsies from another opacity revealed adenocarcinoma of the lung.Curative surgery for the lung cancer confirmed a concurrence of lung cancer and pulmonary MAC infection. Since the prevalence of both of these lung diseases is increasing, suspicion of concurrence is critical to provide appropriate care.

Clinical usefulness of combination chemotherapy for pulmonary Mycobacterium avium complex disease

BACKGROUND: This study compared the clinical usefulness of combination chemotherapy including various doses of clarithromycin (CAM) for pulmonary Mycobacterium avium complex (MAC) disease. METHODS: The subjects were divided into three groups receiving combination chemotherapy at various dose levels of CAM. The analysis of microbiological effects was based on the sputum conversion rate and sputum relapsing rate and that of clinical effects was performed by clinical symptoms and radiological findings for patients with pulmonary MAC disease. RESULTS: There were no significant differences among the three groups with regard to patient characteristics. The sputum conversion rate significantly increased with the dose of CAM (CAM 400mg: 43%, CAM 600mg: 69%, CAM 800mg: 88%). The sputum relapsing rate did not significantly differ among the three groups (CAM 400mg: 47%, CAM 600mg: 35%, CAM 800mg: 33%). Along with the sputum conversion rate, the rate of clinical improvement was significantly increased with the dose of CAM (CAM 400mg: 27%, CAM 600mg: 40%, CAM 800mg: 54%). Adverse reactions, such as gastrointestinal symptoms, were most frequently recognized in the group receiving CAM 800mg (38%) compared to those in the other two groups (CAM 400mg: 23% and CAM 600mg: 25%). CONCLUSIONS: Although both the sputum conversion rate and clinical improvement significantly increased with the dose of CAM, the rate of adverse reactions, such as gastrointestinal symptoms, also increased. It is important to continue close monitoring of patients with pulmonary MAC disease treated with a regimen that includes CAM 800mg.