膿胸を伴った Mycobacterium abscessus による肺感染症の1例

1 1 3 2012 213.. Mycobacterium abscessus 1 .. 68 2000 9 . 2005 Mycobacterium abscessus 2005 3 clar- ithromycin CAM rifampicin RFP ethanbutol EB . 2007 3 2007 8 38 . X CT .. M. abscessus . amikacin AMK . imipenem/cilastatin IPM/. CS . CAM . 6 . IPM/CS AMK faropenem . FAPM . levofloxacin LVFX CAM 3 . 2009 6 2009 12 . 2011 9 . Mycobacterium abscessus Nontuberuculous Mycobacteria Empyema thoracis Mycobacterium abscessus M. abscessus .. clarithromycin CAM .. amikacin AMK . Mycobacterium abscessus Runyon . imipenem/cilastatin IPM/CS 3 .. M. abscessus .. M. abscessus . 68 .. 808-0024 1-17-1 .. 64 Child-Pugh class A .. 2000 9 .. Gaffky 2 .. E-mail: isoniazid INH 300 mg/ rifampi- Received 7 Jun 2011/Accepted 25 Nov 2011 cin RFP 450 mg/ ethanbutol.

2 214 1 3 2012. Table 1 Laboratory findings on admission Hematology Biochemistry Tuberculin skin test 9 8 mm WBC 37,600/ l TP g/dl QFT TB-2G negative Seg 16 Alb g/dl Sputum Stab 72 T-Bil mg/dl Cytology Class I. Eos 0 AST 52 U/L Bacterial normal flora Baso 0 ALT 32 U/L Acid-fast bacilli Mono 1 ALP 453 U/L Smear . Lym 11 LDH 208 U/L Culture . RBC 350 104/ l Glu 118 mg/dl DDH M. abscessus Hb g/dl Na 139 mmol/L Drug sensitivity test MIC g/ml . Hct K mmol/L AMK S 16. MCV fl Cl 106 mmol/L LVFX R 8. MCHC g/dl BUN mg/dl CAM R 8. Plt l Cre mg/dl IPM R 16. ESR 110 mm/h Serology CRP mg/dl . QuantiFERON -TB 2G.. Deoxyribonucleic acid-deoxyribonucleic acid hybridization. Table 2 Result of examinations of pleural effusion WBC 16,700/ l pH Tbc PCR negative Seg 5 TP g/dl Cytology Class I.

3 Stab 86 Alb g/dl Bacterial negative Eos 0 Glu 19 mg/dl Acid-fast bacilli Baso 0 LDH 4,477 IU/L Smear . Mono 0 AMY 44 IU/L Culture . Lym 6 ADA 101 IU/L DDH M. abscessus Others 3 . Mycobacterium tuberculosis.. Deoxyribonucleic acid-deoxyribonucleic acid hybridization. EB 750 mg/ 9 . 2004 9 . X Table 1 . Mycobacterium abscessus . CAM 400 mg/ RFP 450 mg/ EB 750 CRP mg/ 2005 8 mg/dl . Gaffky 2 . 2005 10 X Mycobacterium avium intracellulare complex CAM 400 mg/ RFP 450 mg/ EB 750 polymerase chain reaction PCR . mg/ 3 2007 3 M. abscessus Table 2 . 2007 8 38 . 8 5 glucose 19 mg/dl . adenosine deaminase ADA 101 IU/L . 149 cm 43 kg 111/73 . mmHg 112 /min 28 M. abscessus . /min SpO2 91 O2 3 L/min M. abscessus . X . Fig. 1 .. Mycobacterium abscessus 1 215.

4 Fig. 2 Chest computed tomography on admission, showing right pneumothorax with a small amount of pleural effusion and consolidation with cavity forma- tion, bronchioectasis and small nodular opacities in the right lung. Fig. 1 Chest X-ray film on current admission, show- ing right pneumothorax, with mediastinal shift to the left; collapse of the right upper lobe; small amount of pleural effusion; and infiltration in the left middle AMK IPM/CS CAM 3 . and lower lung fields. 1 . M. abscessus .. CT . consolidation rapidly growing mycobacteria . Fig. 2 . Runyon IV . 7 . 1 M. abscessus .. M. abscessus .. M. abscessus Mycobacterium chelonae M. chelonae . AMK 400 mg/ IPM/CS 1 g/ CAM 600 mg/ M. chelonae 1992 2 3 . M. abscessus .. M. abscessus .

5 AMK IPM/CS 17 4 . CAM 3 6 . 193 . IPM/CS AMK . faropenem FRPM .. levofloxacin LVFX FRPM 1957 1995 40 . LVFX CAM 3 . 2009 6 2004 2. 2009 12 . 2011 9 Jarand 5 69 . American Thoracic Society ATS . M. abscessus .. 48 . M. abscessus 29 . 216 1 3 2012. cephem . 2005 ceftazidime CAZ . CFX . 2007 flomoxef FMOX carbapenem . 1 IPM/CS panipenem PAPM .. meropenem MEPM . FMOX CFX .. 6 7 . MIC IPM/CS PAPM MEPM . MIC CFX . FMOX IPM/CS PAPM . MEPM .. in vitro . M. ab- in scessus vitro in vivo . Kotani . 8 .. 2 M. abscessus . CAM . AMK IPM/CS 13 CAM . RFP EB 14 15 . M. abscessus IPM/CS AMK LVFX CAM . M. abscessus LVFX 16 INH RFP . CAM RFP EB 17 INH RFP ethi- Fairhurst . 9 . onamide minocyclin CAM LVFX 3 . 1 . CAM LVFX 17 CAM FAPM. 18 . IPM/CS FAPM.

6 10 . CAM . M. absces- LVFX CAM FAPM . sus IPM/CS AMK CAM 3 . ATS 2007 M. abscessus CAM LVFX FAPM 3 . CAM azithromycin AMK cefoxitin CFX .. IPM/CS linezolid telithromycin 2009 6 2009. 12 . AMK 2011 9 . CFX 2 AMK IPM/CS CAM . 4 FAPM LVFX CAM 3 . 11 1 M. abscessus 1. M. abscessus . CFX . 2001 M. abscessus . CFX cephem . 12 My- 94 2008. cobacterium Growth Indicator Tube broth 11 . microdilution method minimal inhibitory concen- tration MIC M. abscessus . Mycobacterium abscessus 1 217. 10 Gribetz AR, Damsker B, Marchevsky A, et al. Non- . tuberculous mycobacteria in pleural fluid. Assess- 1 Shinnick TM, Good RC. Mycobacterium taxonomy. ment of clinical significance. Chest 1985; 87: 495-8. Eur J Clin Microbiol Infect Dis 1994; 13: 884-901.

7 11 Griffith DE, Aksamit T, Brown-Elliott BA, et al. An 2 Daley CL, Griffith DE. Pulmonary disease caused by Official ATS/IDSA Statement: Diagnosis, Treat- rapidly growing mycobacteria. Clin Chest Med ment, and Prevention of Nontuberculous Mycobac- 2002; 23: 623-32. terium Disease. Am J Respir Crit Care Med 2007;. 3 Kusunoki S, Ezaki T. Proposal of Mycobacterium 175: 367-416. preregrinum sp. nov., nom. Rev., and elevation My- 12 Cephem . cobacterium chelonae subsp abscessus Kubica et Carbapenem M. abscessus . al. to species status: Mycobacterium abscessus 2003; 78: 587-90 . comb. nov. Int J Syst Bacteriol 1992; 42: 240-5. 13 Clarithromy- 4 Mycobacteri- cin, amikacin, imipenem/cilastatin . um chelonae subsp abscessus 2 Mycobacterium abscessus .

8 1996; 34: 1264-70 2006; 44: 800-86 . 5 Jarand J, Levin A, Zhang L, et al. Clinical and micro- 14 . biologic outcomes in patients receiving treatment Mycobacterium ab- for Mycobacterium abscessus pulmonary disease. scessus 2 2005; 43: 241- Clin Infect Dis 2011; 52: 565-71. 26 . 6 Kakugawa T, Mukae H, Kajiki S, et al. Mycobacteri- 15 . um avium pleuritis in a non-immunocompromised Mycobacterium abscessus . patient. Intern Med 2008; 47: 1727-31. 1 2004; 42: 519- 7 22 . Mycobacterium kansasii 1 16 . 2004; 79: 397-400 Mycobacterium abscessus . 8 Kotani K, Hirose Y, Endo S, et al. Surgical treatment 1 2002; 40: 61-5 . of atypical Mycobacterium intracellulare infection 17 Mycobacteri- with choronic empyema. J Thoracic Cardiovascular um chelonae subsp.

9 abscessus 2 . Surgery 2005; 130: 907-8. 1996; 34: 1264-170 . 9 Fairhurst RM, Kuback BM, Shpiner RB, et al. Myco- 18 Tanaka E, Kimoto T, Tuyuguchi K, et al. Successful bacterium abscessus Empyema in a Lung Trans- treatment with faropenem and clarithromycin of plant Recipient. J Heart Lung Transplant 2002; 21; pulmonary Mycobacterium abscessus infection. J. 391-4. Infect Chemother 2002; 8: 252-25. 218 1 3 2012. Abstract A case of successfully treated pulmonary Mycobacterium abscessus infection associated with empyema thoracis Takeshi Orihashi a, Kazuhiro Yatera b, Masaki Matsuo a, Hiroshi Itoh a, Taizo Yaguchi a, Shinichi Miyazaki c, Akihiro Matushita a, Kazuhiko Machida a, Shouichi Sugaya a and Hiroshi Mukae b Department of Respiratory Medicine, Wakamatsu Hospital of University of a Occupational and Environmental Health, Japan b Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan c Chubu Rosai Hospital d Yokkaichi Municipal Hospital A 68-year-old woman with liver cirrhosis was admitted to our hospital with high-grade fever and dyspnea on exertion in August 2007.

10 Chest computed tomography showed right pneumothorax and consolidation with cavita- tion in the right upper lobe. After the chest tube insertion, yellowish purulent pleural effusion was obtained. Labo- ratory findings of right pleural effusion showed a high level of adenosine deaminase 101 IU/L and a low glucose level mg/dl with positive smear with positive smear results of acid-fast bacilli. Mycobacterium abscessus was then confirmed by cultivation of both sputum and right pleural effusion. Her clinical symptoms and radiological findings were improved by the combination therapy with clarithromycin, amikacin, and imipenem/cilastatin for 6. months followed by combined oral treatment with clarithromycin, panipenem, and levofloxacin.