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結核 第 89 巻 第 12 号 2014 年 12 月 824

Abstract  [Objective] There are few reports describing pleu-risy caused by nontuberculous pulmonary mycobacteriosis; in addition, there are few reports describing the frequency of cases.

 [Method] We retrospectively studied 116 consecutive cases of nontuberculous mycobacteriosis occurring between Janu-ary 2009 and JanuJanu-ary 2014.

 [Result] Of these, 7 patients (6.0%) were diagnosed with pleuritis caused by nontuberculous pulmonary mycobacterio-sis. One patient each had a history of ulcerative colitis, rheu-matoid arthritis treated with steroids, and retinitis pigmentosa. Pleural effusion was examined in all 7 cases. In addition, non-tuberculous mycobacteria were cultured from pleural effusion in 4 of the 7 cases; all were cases of Mycobacterium avium complex infection. The mean adenosine deaminase level in pleural effusion was 86 U/mL, and in 5 out of 7 cases, the

adenosine deaminase level was greater than 50 U/mL. Pneu-mothorax occurred with pleuritis in 5 cases. Pleuritis was treated with NTM therapy in 5 cases, and pleural effusion decreased or cleared completely in all cases.

 [Conclusion] To reveal pleurisy accompanied by non-tuberculous mycobacteriosis, further consideration is needed. Key words: Nontuberculous mycobacteriosis, Pleurisy, Pneu-mothorax

Takatsuki Red Cross Hospital

Correspondence to: Toshikatsu Sado, Takatsuki Red Cross Hospital, 1_1_1, Abuno, Takatsuki-shi, Osaka 569_1045 Japan. (E-mail: toshsado@gmail.com)

−−−−−−−−Original Article−−−−−−−−

CLINICAL ANALYSIS OF NONTUBERCULOUS MYCOBACTERIAL

INFECTION COMPLICATED BY PLEURISY

Toshikatsu SADO, Yasukiyo NAKAMURA, and Hideo KITA 2 ) Christensen EE, Dietz GW, Ahn CH, et al.: Pulmonary

Man-isfestations of Mycobacterium intracellularis. AJR. 1979 ; 133 : 59 66.

3 ) 市木 拓, 植田聖也, 渡  彰, 他:胸膜炎を合併した 肺非結核性抗酸菌症の検討. 日呼吸会誌. 2011 ; 49 : 885 889.

4 ) Kotani K, Hirose Y, Endo S, et al.: Surgical treatment of atypical Mycobacterium intracellulare infection with chronic empyema: A case report. J Thoracic Cardiovascular Surgery. 2005 ; 130 : 907 908.

5 ) Okada Y, Ichinose Y, Yamaguchi K, et al.: Mycobacterium avium-intracellulare pleuritis with massive pleural effusion. Eur Respir J. 1995 ; 8 : 1428 1429.

6 ) 川本 仁:右胸水で発症したMycobacterium avium com-plex 症の一例. 日呼吸会誌. 2000 ; 38 : 706 709.

7 ) Nagaia T, Akiyama M, Mita Y, et al.: Mycobacterium avium complex pleuritis accompanied by diabetes mellitus. Diabetes Res Clin Pract. 2000 ; 48 : 99 104.

8 ) Yanagihara K, Tomono K, Sawai T, et al.: Mycobacterium avium complex pleuritis. Respiration. 2002 ; 69 : 547 549. 9 ) Gribetz AR, Damsker B, Marchevsky A, et al.:

Non-tuberculous mycobacteria in pleural fl uid. Assessment of clinical signifi cance. Chest. 1985 ; 87 : 495 498.

10) 萩原恵里, 椎原 淳, 榎本崇広, 他:気胸を合併した非 結核性抗酸菌症16例の臨床的検討. 日呼吸会誌. 2010 ; 48 : 104 107. 11) 石黒 卓, 高柳 昇, 齊藤大雄, 他:Mycobacterium avium complexによる胸膜炎の2例. 日呼吸会誌. 2010 ; 48 : 151 156.

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834 結核 第 89 巻 第 12 号 2014 年 12 月

−−−−−−−−Report and Information−−−−−−−−

TUBERCULOSIS ANNUAL REPORT 2012

─ (4) Tuberculosis Treatment and Outcomes ─

Tuberculosis Surveillance Center (TSC), RIT, JATA Abstract Re-treatment frequency among patients newly

diagnosed with tuberculosis (TB) might indicate inadequate prior treatment. Of 21,283 patients diagnosed with TB in 2012, 1,336 had received prior TB treatment. Among patients requiring re-treatment, more than half (n=749) had received treatment after 2000. The initial recommended TB treatment regimen in Japan consisted of a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin. This regimen was used to treat approximately 90% of patients aged 15_49 years with all forms of TB. However, the proportion of patients substantially declined among patients ≧80 years of age. Of 13,650 patients who started a pyrazi-namide TB treatment regimen in 2011, approximately 10% were unable to complete the 2-month-long pyrazinamide regimen by the end of 2012.

 In 2012, 16,432 patients were newly diagnosed with pulmo-nary TB (PTB). The proportion of patients hospitalized at the beginning of TB treatment increased among those ≧30 years of age. The median hospitalization duration among newly diagnosed patients with all forms of TB in 2011 was 64 days. The durations for those who had a new positive sputum smear result, were undergoing re-treatment, had a positive sputum result in other bacteriological tests, and had bacteriologically negative sputum PTB were 70, 72, 44, and 39 days, respectively. The median hospitalization duration was 43 days among patients with extrapulmonary TB. At the end of 2012, the median treatment duration in patients

diagnosed in 2011 with all forms of TB was 273 days.  The treatment success rates for patients who had a new positive sputum smear result (n=7,736), were undergoing re-treatment (n=747), had a positive sputum result in other bacteriological tests (n=6,049), and had a bacteriologically negative sputum result (including other PTB patients) (n=2,917) registered in 2011 were 50.6%, 41.2%, 58.0%, and 62.5%, respectively. The rate of loss to follow-up among patients who had a new positive sputum smear result and were undergoing re-treatment was 3.3% each, well below 5%. The mortality rate among patients with new sputum smears posi-tive for PTB was 21.6%; >20% died before completing the treatment course. Patients 70_79, 80_89, and ≧90 years of age had relatively high death rates (23.9%, 36.6%, and 44.0%, respectively) compared with the other age groups. Key words : Tuberculosis, Treatment history, Treatment status, Duration of treatment, Treatment outcomes

Research Institute of Tuberculosis (RIT), Japan Anti-Tubercu-losis Association (JATA)

Correspondence to: Tuberculosis Surveillance Center (TSC), Research Institute of Tuberculosis (RIT), JATA, 3_1_24, Matsuyama, Kiyose-shi, Tokyo 204_8533 Japan.

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