(Vol.75 No.4 April 2000) <1>Kekkaku Vol.75, No.4:341-347, 2000 EVALUATION OF CT APPEARANCE OF MYCOBACTERIUM AVIUM COMPLEX INFECTION -Comparison with Bronchiectasia- *Sanae OCHIAI, Yasuko KIDO, Sachiko TANOUE, Yoshinari KITAHARA Yasuko HARADA, Susumu HARADA, Masahiro TAKAMOTO, and Tsuneo ISHIBASHI *Department of Internal Medicine, National Ohmuta Hospital We compared computed tomographic pictures (CT) of primary pulmonary mycobacte- rium avium complex (MAC) infection with bronchiectasia (BE). These patients were examined during the period from 1988 to 1996. There were 51 patients of pulmonary MAC infection group (13 males and 38 females) with a mean age of 67.5 years and 27 patients of BE group (8 males and 19 females) with a mean age of 53.9 years. The results were as follows: 1.In both groups, bronchiectasis was most commonly found in the middle lobe and in the lingula. In pulmonary MAC infection group, 38 patients (74.5%) had bronchiectasis in the middle lobe, and 40 patients (78.4%) had them in the lingula. In BE group, 18 pa- tients (66.7%) had them in the middle lobe and in the lingula respectively. In the lower lobe, bronchiectasis of BE group was observed more frequently. And in pulmonary MAC infection group, 15 patients (29.4%) had bronchiectasis in the central zone, 42 patients (82.4%) had them in the intermediate zone, and all 51 patients had them in the periph- eral zone, On the other hand, in BE group, 18 patients (66.7%), 27 patients (100%) and 21 patients (77.8%) had them in the central zone, in the intermediate zone and in the peripheral zone respectively. Bronchiectasis of pulmonary MAC infection was observed in peripheral zone more frequently than that of BE group. 2.By the type of bronchiectasis, saccular bronchiectasis was observed more frequently in BE group than in pulmonary MAC infection group. 3.Nodules were seen in pulmonary MAC infection group significantly more than in BE group. They were seen in 96% of lobes with bronchiectasis, and 50% of lobes without bronchiectasis in pulmonary MAC infection group. It was thought that the bronchiectasis with nodules predominantly in the peripheral zone was a characteristic CT finding of primary pulmonary MAC infection. As this find- ing was different from that of BE, it is suggested that primary pulmonary MAC infection caused this type of bronchiectasis. Key words: Mycobacterium avium complex infection, Bronchiectasis, Computed tomography *1044-1, Tachibana, Oaza, Omuta-shi, Fukuoka 837-0911 Japan. (Received 7 Oct. 1999/Accepted 3 Dec. 1999) <2> Kekkaku Vol.75, No.4:349-353, 2000 A CLINICAL STUDY ON PULMONARY TUBERCULOSIS IN YOUNGER AGE GROUPS 1*Makoto TAKAHARA, 2Tsuneo SUZUKI, 2Emiko TOYOTA, 2Nobuyuki KOBAYASHI, 2Hiroshi KAWADA, and 2Kouichirou KUDOH 1*Department of Internal Medicine, National Nishi-Koufu Hospital, 2Department of Respiratory Diseases, International Medical Center of Japan In 1997, the number of newly registered patients with pulmonary tuberculosis in- creased, compared with that in 1996, in Japan. The majority of the increase were occupied by elder patients 70 years of age or higher. But in younger group less than 30 years old, a reduction in the incidence of tuberculosis had been slowed down, until 1996. The pur- pose of this report is to elucidate the characteristics of these younger patients. 139 cases younger than 30 years of age, who were hospitalized in the tuberculous ward of IMCJ from April 1995 to March 1998, were investigated, and were compared with the control group (557 cases), 30-79 years old who were hospitalized during the same period. In the younger group, the proportion of women cases, discovered by health examination, for- eigners, and contact with TB patients in the past was significantly higher than in the control group. But there were no difference between the both groups, concerning the pro- portion of those spending irregular life or living alone. The proportion of sputa smear negative cases was significantly higher in the younger group than in the control. For early diagnosis of TB among younger group, the application of bronchofiberscopy and nucleic acid diagnostic method, are encouraged. Key words:Younger group, Irregular life, Smear negative culture positive, Early diagnosis *3368, Yamamiya, Kofu-shi, Yamanashi 400-0075 Japan. (Received 7 Oct. 1999/Accepted 13 Dec. 1999) <3> Kekkaku Vol.75, No.4:355-361, 2000 THE FREQUENCY PROFILE OF TUBERCULIN SKIN TESTING AMONG EMPLOYEES OF A HOSPITAL 1*Yoshinori MITA, 1Kunio DOBASHI, 2Tsugio NAKAZAWA, and 1Masatomo MORI 1*First Department of Internal Medicine, Gunma University Faculty of Medicine, 2Gunma University School of Health Sciences The frequency profile of tuberculin skin testing among employees of a hospital was studied. In the analysis, tuberculin skin testing was defined as ήnegative" if skin rash is measured … 9mm, and as "positive" if skin rash is measured † 10mm, and as "strongly positive" if skin rash is measured † 10mm, with induration, and double skin rash or bulla. Boosting was defined as initial skin rash was measured … 9mm, with second skin rash measured † 10mm and at least 6mm increase of rash than the initial one. 544 employees were tested initially, and 81 were retested. Initial tuberculin positivity was associated with older age (pƒ0.001); but boosting was not associated with age and occupation. Comparing pharmacists with other groups, the adjusted odds ratio of an ini- tial strongly positive tuberculin reaction as significantly higher, namely 2.8 (95% confi- dence interval 1.2`6.7), but that of a booster reaction was 4.8 (0.7`32.1) which was insignificant. Key words : Tuberculin, Two-step tuberculin test *3-39-15, Showa-machi, Maebashi-shi, Gunma 371-8511 Japan. (Received 18 Oct. 1999/Accepted 4 Jan. 2000) <4> Kekkaku Vol.75, No.4:363-368, 2000 TUBERCULIN SURVEY OF UNIVERSITY STUDENTS AND POSTGRADUATES IN 1998 1Takao NOSHIRO, 1,2*Ken SATO, and 1Yukio MIURA 1Health Administration Center, Tohoku University, 2*Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging, and Cancer, Tohoku University, 3Miyagi Branch, Japan Anti-Tuberculosis Association As no recent report has been made concerning the tuberculin survey of healthy young adults in Japan, we checked all the Tohoku University undergraduate and postgraduate students by tuberculin test for the assessment of TB-situation in 1998. The sample included 5,517 students and postgraduates (3,888 males and 1,629 females ; 31% of all subjects to be tested) who were evaluated on the basis of the redness of the skin test. The average age of the subjects was 22.3}3.1 years old (ranging from 18 to 51). As a result of this survey, 5,032 (91.2%) were positive and 485 (8.8%) were negative, and the average diameter of redness was 28.5}19.2mm. Non-reactors received an additional BCG vaccination. Subjects showing strongly-positive (20.1%) results were rechecked by physical examination and chest X-ray, and none was found to require treatment by anti-TB drugs. Our findings also demonstrated that the diameter of redness was larger in the group previously BCG-vaccinated than in the group who had not received BCG vaccination previously (pƒ0.01). Key words : Tuberculosis, Tuberculin reaction, BCG, University student, Group tuberculosis-examination *4-1, Seiryo-cho, Aoba-ku, Sendai-shi, Miyagi 980-8575 Japan. (Received 14 Jul. 1999/Accepted 20 Dec. 1999) <5>Kekkaku Vol.75, No.4:369-374, 2000 PULMONARY INFECTION CAUSED BY MYCOBACTERIUM GORDONAE IN IMMUNOCOMPETENT PATIENT 1*Yuka FUJITA, 1Hiroyuki MATSUMOTO, 2Toshiaki FUJIKANE, 1Shoko NAKAO, 1Nobuhiko SASAKI, 1Masaaki TAKAHASHI, 1Kazue SATO, 1Akinori TAKEDA, 1Yasuhiro YAMAZAKI, and 1Katsuyuki TOBISE 1*Department of Internal Medicine, National Dohoku Hospital, 2Department of Internal Medicine, National Nayoro Hospital We report a case of 67-year-old female immunocompetent patient admitted to our hospital because of hemoptysis. Computed tomography (CT) of the lung showed bronchi- ectasis in the right S(5) and small nodules in the right S(6) and left S(5). The cultures of spu- tum and bronchial washing specimen repeatedly revealed acid-fast bacilli identified as Mycobacterium gordonae (M. gordonae) by DNA-DNA hybridization (DDH) method. Thus, she was diagnosed to be infected with M.gordonae. She was treated with isoniazid, rifampicin, ethambutol and streptomycin. After treatment, the cultures of sputum and bronchial washing specimen converted to negative, and the chest CT showed improvement of small nodules. M. gordonae is a nontuberculous mycobacterium of very low pathogenic potency. Recently there have been a few reports of infection by M. gordonae not only in immunocompromised patients but also in immunocompetent patients. These cases were considered to be sensitive to initial standard antimycobacterial therapy, therefore, it is important to examine for M.gordonae in cases suspected of nontuberculous mycobacte- rial infection. Key words : Mycobacterium gordonae, Nontuberculous mycobacteriosis, Mycobacterium avium complex, CT appearance, Standard antimycobacterial therapy *7, Hanasaki-cho, Asahikawa-shi, Hokkaido 070-8644 Japan. (Received 4 Aug. 1999/Accepted 20 Dec. 1999)