Mycobacterium abscessus 肺感染症の2例 - jrs.or.jp

1 43 4 2005 241.. Mycobacterium abscessus 2 . 1 2 1 1 . 1 2 2 . 1 66 . rifampicin RFP . ethambutol EB . clarythromycin CAM . 2 74 . Isoniazid INH . RFP EB pyradinamide PZA . EB, clarithromycin CAM . ciprofloxacin CPFX Mycobacterium abscessus M. abscessus MIC . M. abscessus MIC .. Mycobacterium abscessus . Mycobacterium abscessus Non-tuberculous mycobacteria Treatment Drug susceptibility testing lulare M. scrofulaceum .. 1998 1999. 3 4 . Mycobacterium avium CT . complex MAC M. kansasii . 152 cm 40 kg . M. abscessus 130! 76 mmHg .. M. abscessus Table 1 .. 2 .. DNA-DNA hybridyzation DDH . M. abscessus .. Fig. 1 . S6 S5 S6 . 1 66 . 1994 1996 M. intra- Fig. 2 . 61 cellulare M. scrofulaceum .. 2 2003 . 1994 M. intracel- 1 M. abscessus . rifampicin RFP . ethambutol EB . claryth- 920 1183 103 1. 1 . romycin CAM . 2 . EB . 16 9 6 . 242 43 4 2005 . Table 1 Laboratory findings on admission Case 1 Case 2 Case 1 Case 2. WBC 7,300 2,700 GOT IU/l 23 9. Neu % 70 76 GPT IU/l 21 10.

2 Eos % 4 1 ALP IU/l 196 120. Lym % 20 17 -GTP IU/l 17 10. RBC / l 417 104 164 104 LDH IU/l 343 120. Hb g/dl Na mEq/l 137 134. Ht % 37 K mEq/l Plt / l 104 104 Cl mEq/l 102 102. CRP mg/dl ESR mm/h 11 161. IgG mg/dl 1,670 4,156 PPD test mm 4 3 0 0. TP g/dl Sputum Alb % Bacteria normal flora normal flora 2-glob % AFB Smear GFK 1 GFK 1 . -glob % Culture . BUN mg/dl 17 DDH M. abscessus M. abscessus Cr mg/dl 2 74 .. 70 .. 20 ! 50 .. 1999 IgG- DS IIIA . melphalan predni- solone 2003 11 .. a 161 cm 61 kg . 112! 60 mmHg .. Table 1 . CRP . IgG globulin .. Fig. 3 .. Fig. 4 . MP . b . isoniazid INH . Fig. 1 a Chest radiograph and b CT scan on admis- RFP EB pyrazinamide PZA 4 . sion of case 1 showing a small nodular shadow with bronchiectasis in the right middle lobe, lingular seg- . ment and the left lower lobe, and a small cavity in the INH EB PZA levofloxacin LVFX . right lower lobe.. DDH M. abscessus . M. abscessus 2 243. Fig. 2 Clinical course of case 1. 1 1 . M. abscessus .

3 CAM minimum inhibitory concentration MIC LVFX . ciprofloxacin CPFX .. M. abscessus .. a . Griffith M. abscessus . 20 . 19 1 M. abscessus 2 .. M. abscessus . 29 . 50 . b 6 . 1 . Fig. 3 a Chest radiograph and b CT scan on admis- 2 . sion of case 2 showing infiltrative shadows with cavity . formation in the right upper lobe. 244 43 4 2005 . Fig. 4 Clinical course of case 2. Table 2 Drug sensitivity test MIC g/ml . Case 1 Case 2 Case 1 Case 2. INH R R IPM 100 100. INH R R MEPM ND 50. RFP 40 R R PAPM ND 100. EB R R CPFX 50 KM 20 R R MINO 100 100. TH 20 R R CAZ ND 100. EVM 20 R R LVFX 50 100. PAS R R CAM 100 CS 30 R R AMK 25 PZA 1,000 R R. CAM amikacin AMK . cefoxitin CFX . imipenem ATS IPM . AMK CFX 2 4 . M. kansasii . RFP 3 M. abscessus 8 . 3 PH M. absces- MAC CAM MIC sus flomoxef FMOX IPM panipenem PAPM mero- penem MEPM 4 . 3 M. abscessus . M. abscessus in vitro . M. abscessus 2 245. MIC . 5 . 8 . 4 5 64 .. MIC .. Table 2 .. Middlebrook 1 . MIC 1 2003 . CAM 2 2003 ; 78 : 569 572.

4 CAM CPFX AMK MIC 2 Griffith DE, Girard WM, Wallace RJ Jr : Clinical fea- tures of disease caused by rapidly growing myco- bacteria. Am Rev Respir Dis 1993 ; 147 : 1271 1278. 2 . 3 American Thoracic Society : Diagnosis and treat- MIC quality of life ment of diseases caused by nontubercurous myco- QOL .. bacteria. Am J Respir Crit Care Med 1997 ; 156 : . s1 s25. 4 Cephem . 1 RFP EB CAM Carbapenem M. abscessus . 2 2003 ; 78 : 587 590. LVFX 5 Mycobacterium 2 chelonae subsp. abscessus 2 . 1996 ; 34 : 1264 1270. in vitro 6 . Mycobacterium chelonae abscessus 2001 ; 11 : 1025 1029.. 7 Tanaka E, Kimoto T, Tsuyuguchi K, et al : Success- in vivo in ful treatment with faropenem and clarythromycin vitro . of Mycobacterium abscessus imfection. J Infect Che- . mother 2002 ; 8 : 252 255.. 8 Mycobacterium abscessus 1 2003 ; 41 : 546 550. MIC 9 Steadham JE, Stall SK, Simmank JL : Use of the 9 10 BACTEC system for drug susceptibility testing of Mycobacterium tuberculosis, M. kansasi, M.

5 Avium complex. Diagn Microbiol Infect Dis 1985 ; 3 : 33 40. 10 Heifets L : MIC as a quantitative measurement of MAC the susceptibility of Mycobacterium avium strains to seven antituberculosis drugs. Antimicrob Agents . Chemother 1988 ; 32 : 1131 1136. 11 M. abscessus 11 .. 1998 .. 1998 ; 73 : 599 605.. 246 43 4 2005 . Abstract Two cases of pulmonary infection by Mycobacterium abscessus in which drug susceptibility testing results conflicted with clinical courses Yoriko Nishizawa1 , Masaki Fujimura2 , Atsurou Tagami1 , Miki Abo1 , Chihiro Honjyo1 , Masahide Yasui2 and Shinji Nakao2 . 1 . Department of Respiratory Medicine, National Hospital Organization, Kanazawa Wakamatsu Hospital 2 . Department of Respiratory and Hematology Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science We encountered two cases of pulmonary infection by Mycobacterium abscessus M. abscessus . Case 1 A 66- year-old man who had been treated for non-tuberculous Mycobacterium in the past was admitted because of pro- ductive cough.

6 His chest X-ray film showed cavitation and direct microscopy of sputum revealed positive acid-fast bacilli AFB .He was given rifampicin RFP ,ethambutol EB , and clarythromycin CAM ,and then his symp- toms and radiographic findings improved. Case 2 A 74-year-old man with multiple myeloma as an underlying disease was admitted because of a cavitation found on chest radiography and a positive result for AFB in his spu- tum. Standard antituberculous drug therapy with isoniazid INH ,RFP, EB, and pyradinamide PZA was initi- ated and then the chest radiographic findings improved. As M. abscessus was isolated two weeks after the induc- tion of therapy, the therapeutic regimen was changed to another combination therapy consisting of EB, clarithro- mycin CAM and ciprofloxacin CPFX , and then his symptoms and radiographic findings were further im- proved. In both cases, the bacilli found in their sputum were identified as M. abscessus by DNA hybridization. They were completely resistant to all anti-tuberculosis agents and many antibiotics with a high value of MIC.

7 However, their symptoms, radiographic abnormalities and the results of sputum examination improved following chemotherapy. The results obtained by MIC measurement were inconsistent with the clinical outcomes. The measurement of the MIC value of antibiotics do not necessarily predict its therapeutic effect.