AIDS Mycobacterium avium - jscm.org

1 AIDS Mycobacterium avium 1) 2) 3) 4) 4) 3) 3) 3) 5) 1) "6)1) #$#$% &' &('2) #$#$% )*+3) , - -'+,% - &''4) #$#$% % '5) , - -'//-+% % &'-12% 1 3346) #$#$% 56*+ 4520 1830 97 4520 6813 9 46Q >' @ B; C '= E F 9 @AMRI(T2WI) GHCAA B J%D G O >' @ B; MRIQ R %D R T U BL M % V XY &'[\ ^_ `PRR PR1& 5 CAA 1& &' cMycobacterium avium [ S M. avium @A O HIV e HTLV-1 Og Q c Ujk V W m n ko ' V Q c j AIDS Y AIDS Q cst Ouvj Key words: Mycobacterium avium @A AIDS w Mycobacterium , \]Q c _yz ){ | `a b % [} nV ~ Q T g y e goG O[ Y h Q 75 T Q c ( kj5 ij/k' kj2 G @ & O GY 1) n Mycobacterium aviumcomplex MAC M.]]]

2 AviumOM. intracellu-larekj c V [ 70 GY 2) G V W w(AIDS) eYG M. avium V [ j GY AIDS eYGPRe CAkjM. avium & Qq 46Q E >' @ B; C '= r s O %r 2006 48 ct v[ c OwU cx GY 68 `>' @ B; 12 mm = 9 @ 1& j [ {Q O o 78 38 ~ >' @ B; V O Q2 cW ( B ` ( 392 8510) # c5 11 50 #$#$% &' &(' TEL: 0266 52 6111 FAX: 0266 57 6036E-mail: - 1 - Vol. 18 No. 3 2008. - 1 - 200831193 8 ! "# ( *+ ! . 2007 2 /0 23 4 5 CT" "6 :; 5 <=> # @A ;C DE @HIJK 3 C DE @L N P DE R 3 S0 4 S0 T UV"W " 4 /0 ;X Y " Z 5 \MRI (T2WI) 5Y\\] ^ `abc d f < gh W i @C DE j MRI<@^ kl n1A klp DE 6 UWu@ "w k E < V \] k }k uptake n1B Ga E < ~C / \CT< k k n1C C CT< ~C ^Q@DE I @ n1D 2W f 1 C DE ~}k @kl " N N ] W klR DE ` W #SBenceJones Protein < < kl W ] p-ANCA, c-ANCA < UV< 6 R W ( *U \R still Wu w " ` n1.)))

3 F A,Y\MRI; B,k E C, \CT, D,C CT ` ` - Vol. 18 No. 3 HIV HTLV-1 ! # %& ()*+ , - / # Ziehl Neelsen 1 56 () 89 , => ? @A 56 B , D E * GHIJ 56 89 , L N L QR # CT TU L Y2 [ ] 5_ (L5) +a*bI cd + efIJ Lg hi GHIJ M. aviumNI& M. avium mno hi p r 300 mg/t u x 750 mg/t z{ T 1g} 3 T 600 mg/t*4 4 h z{ T } 400 mg/t a T 800 mg/t * 8 u x 4z MRI> Q a N N CRP _ p G U hN E () LLg LbI L5 bI * GHIJ c IJ Ziehl Neelsen 1 c , WBC20,200 AST22 ALT24 LDH222 ALP330 IU/LRBC443 104 104 ng/ml 6 40 86 IU/ml SS-A/Ro SS-B/La SIL-2 3030 U/mlY2.

4 CT TU * L+a*bI AIDS 56 GH * AIDS 56 GH * t b Vol. 18 No. 3 PCR # ) + ,- 0 1 12 1 5 4 8 ; 2 + <,- 0 1 = ?? + AB !2 " CD E# F$ 1 AB + IJ & () D (1 ) PCR M) N L5- P M. aviumR . () D / 1 PCR S2R V R P R ;3 D FYZ 45P 6FY; K + DNA 7. PCR :; . () D 8 ]; M) 6 ]; L5- 7 ]; =^ >_ PCR M. avium :? 1@ABC a b Ac a d e -SR F AB g (S), h j Y (R), Z m (S),no p (R), (S),n dr (S),n r s (R), u (S),FY s (R),gvZ (S) ) N -P M. avium . HAIDS I= -x b M. avium L z{ }~ NO + P R a ? MACa I W# a + HAc Y MAC = Z [Ac [ [ [ ]^ _ 3), 4) ab ba d f R= Z g + 4) j M.

5 Aviuma V Ia R f R R mI nb p 8 r st >_ ? u D v >_ 5) Q NxI CD J >_ P a ^ z V } N HIV J HTLV-1 J N+ ~ 2006 12 g 30 mg 2007 4 2mg? e RQ 12 mg? ? p R N = R= f I HAIDS HAc + o Z (IFN)g 6) z IFNggu o 7) R + Q IFNg z + + +R f + HAIDS N HAc I= -xzj HAc ? b I R P N . ? ? b R M) P PCR M. aviumR . 1 & RJ P P a ] R P P P os f I P - P IPCR M. aviumR . R>_ 2 R ? & PCR AB + & RZiehl Neelsen & _ & # / Y Y & R R NO + / # ABR R ?

6 Ziehl Neelsen 1,000 g _ R + 8) R } N = f R () D & R R:1 PCR S2R :? P g e p D FYZ 45P DNA 7. PCR M. avium . FYZ p ] PCR R f & N PCR !2. AB& PCR CD( )( )( )E# F$( )( )( )() D(1 )M. avium M. aviumM) ( )M. avium M. aviumL5- ( )M. avium M. avium 1( )( )( ) D FYZ 45 DNA 7. W W3Q Vol. 18 No. 3 ! % PCR & ' ( ) *+ / % 3 4 67 9 : 4 % BacT/Alert3D < > @ 3 C 4 D E 9), 10) FG % SA I < > @ BacT/Alert3D 60 L4 M ! BacT/Alert3D : D11) 6 Ziehl Neelsen "O P Q RS %U PCR M. avium DW X' AIDSY * M. avium \" 90 _ +4 E 5) FG % 4 PCR ` b/ D 6 4 c 6 de7 4 67M.

7 avium D 6740 * \"f3` gh 9 FG476 6 % PCR +j Qm 'no 6 + 9 MAC *+ p q: " s u vw FG w Y <= D D> y | } @ D w y 9 AB de7 ` C D44G E % % C 9 I _ M / M 1) David, E. G., T. Aksamit, B. A. Brown-Elliott, etal. 2007. An o$cial ATS/IDSA statement: Di-agnosis, treatment, and prevention of non-tuberculous mycobacterial diseases. Am. Crit. Care Med. 175: 367 ) P 1998. Q os 1998 73: 599 ) U VW X 1994. A0 [ +6 * 1C 69: 19 ) W] ` W 1990. b PPD 65: 341 ) Inderlifd, C. B., C. A. Kemper, L. M. TheMycobacterium aviumcomplex. Rev. 6: 266 ) Tanaka, Y., T. Hori, K. Ito, et al. 2007. Dissemi-natedMycobacterium aviumcomplex infectionin a patient with autoantibody to Medicine 46: 1005 ) Ottenho#, , F.

8 A. Verreck, E. G. Lichtenau-er-Kaligis, et al. 2002. Genetics, cytokines andhuman infectious disease: lessons from weaklypathogenic mycobacteria and salmonellae. 32: 97 ) Q % + 2000. % ' h 9 175: 681 ) Hanscheid, T., C. Monterio, J. Melo Cristino, etal. 2005. Growth ofMycobacterium tuberuculo-sisin conventional BacT/ALERT FA bloodculture bottles allows reliable diagnosis of my-cobacteremia. J. Microbiol. 43: 890 ) Kasuga, E., T. Matsumoto, K. Oana, et al. of BacT/Alert 3D SA Bottles foraccurate Detection of Mycobacteremia withspecial reference toMycobacterium J Med Res. 12: 43 ) i 2006. : 4 % 3D. ' k33:67 71. AIDS* 3C AIDS* 3C ' k Vol. 18 No. 3 of Multiple Osteomyelitis Due toMycobacteriumaviumin an Non-AIDS PatientHarumi Oguchi,1)Toshio Sato,2)Takefumi Suzuki,3)Shinya Houkibara,4)Masahiko Shimomura,4)Eriko Kasuga,3)Takehisa Matsumoto,3)Eiko Hidaka,3)Yoshiyuki Kawakami,5)Kazuo Morozumi,1)Tsutomu Hachiya6)1)Department of Laboratory Medicine, Suwa Red Cross Hospital2)Department of Cardiology, Suwa Red Cross Hospital3)Department of Laboratory Medicine, Shinshu University Hospital4)Department of Pathology, Suwa Red Cross Hospital5)Department of Biomedical Laboratory Sciences, School of HealthSciences, Shinshu University School of Medicine6)Department of Respiratory, Suwa Red Cross HospitalNon-tuberculous mycobacteria are known to cause opportunistic infectious diseases in immunocom-promised patients.

9 We encountered a case of disseminated non-tuberuculous mycobacteriosis due toMycobacterium was a 46 year-old woman who was transferred to our hospital because ofconspicuously abnormal high-intensity area on lumbar vertebrae by means of MRI scanning chief complaints were fever, cervical lymphadenopathy, and low back pain. She was evident ofprogressive cervical lymphadenopathy and myelitis, and therefore was suspected of a bone marrowdisease, metastatic carcinoma, connective tissue diseases, and tuberculosis. Finally, she was diagnosed asmultiple osteomyelitis by the successful detection ofM. aviumfrom her iliac bone marrow fluid and biopsyof right iliac bone and 5th lumbar vertebra. She was demonstrated to be negative in both HIV and HTLV-1antibody tests, and demonstrated to possess no indicative sign of immunodeficiency.

10 She was treated inoutpatient clinic with combined administration of three anti-tuberculous drugs comprising of ethambtol,kanamycin, rifampicin, together with clarithromycin. The extrapulmonary infection withM. aviumhasrarely been described. This was an infrequent case of disseminatedM. aviuminfection, occurred in anon-AIDS female patient lacking in immunodeficiency. Vol. 18 No. 3 2008. 36198