[Immunological studies in cases of pulmonary Mycobacterium avium complex infection without predisposing conditions].

Peripheral blood mononuclear cells (PBMCs) taken from 39 primary pulmonary MAC patients and 11 control subjects were stimulated in vitro with a protein antigen PPD-B derived from M. intracellulare. Then, the activated response of the peripheral blood lymphocytes (PBLs) and the production of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) were measured. The 39 primary pulmonary MAC patients were divided into A and B groups the former patients satisfying all of the criteria for the diagnosis of nontuberculous mycobacterial disease proposed by the American Thoracic Society, with the exception of the bacteriologic criteria, and the latter, who satisfied all without exception. The 39 patients were also divided into 3 groups according to disease severity judged from chest CT features. Severity in grades 1, 2 and 3 groups were mild, moderate and severe, respectively. We compared the activated response of PBLs and the production of IFN-gamma and IL-10 by PBMCs of the control group and each patient group. The number of lymphocytes and activated T cells and the concentration of the IFN-gamma after stimulation with PPD-B were lower in each group of primary pulmonary MAC patients than in the control group. IL-10 was significantly higher in each group of primary pulmonary MAC patients than in the control group (36.6 +/- 11.8 pg/ml), and higher in group B (131.6 +/- 14.9) than in group A (81.1 +/- 31.5). There was no significant difference in the IL-10 concentration between the grade 1, 2 and 3 groups. These results suggested that the cell-mediated immunity of primary pulmonary MAC patients was suppressed as the disease progressed, and the increased production of IL-10 was related to this suppression.

[The effect of intravenous ciprofloxacin for community acquired pneumonia in adults].

To verify the indication of intravenous fluoroquinolone in guideline for treatment of community-acquired pneumonia published in Japanese Respiratory Society, the effect of intravenous ciprofloxacin was investigated in this study. 49 cases of community-acquired pneumonia were treated by intravenous ciprofloxacin. Total response rate was 77.1%. 66.7% of response rate was achieved even in the cases which other antibiotics had been already introduced and failed. The data of this study indicated that intravenous ciprofloxacin was one of the effective and appropriate therapeutics for community-acquired pneumonia in adults.

[A clinical study on cases with pulmonary M. avium complex (MAC) disease followed up for more than 10 years].

We performed a clinical study on 22 cases with pulmonary M. avium complex disease followed up for more than 10 years. The mean age of these patients at the first visit was 60.1 years old and the extent of the disease among them was minimum or moderate. The progression of the disease was relatively slow. There were 5 cases of tuberculosis-like type and 11 cases of nodular-bronchiectasis type among the primary infection type and 6 cases of the secondary infection type. Classifying these cases by the grade of progression on chest X-ray findings, 2 cases improved, 11 cases slightly progressed, 4 cases moderately progressed and 5 cases severely progressed. Seven cases of the nodular-bronchiectasis type of the primary infection type were observed among 11 slightly progressed cases. This suggested that the prognosis of cases with nodular-bronchiectasis type was relatively good. The frequency of a reaggravation of chest X-ray findings was significantly higher in the severely progressed cases than in the slightly and moderately progressed cases. Generally, the number of used drugs was more and the duration of treatment was longer in the severely progressed cases. This suggested that these cases were intractable. The results of sputum culture for M. avium complex were consistent with the progression of the disease shown on chest X-ray findings among many cases. However, sputum culture negative was observed in some cases with the nodular-bronchiectasis type in spite of the reaggravation on chest X-ray findings. On the other hand, there were some cases in which few reaggravation was observed in spite of continued sputum culture positive. Based on these results, we made some remarks on the treatment and management of pulmonary M. avium complex disease.

[A clinical study of deceased cases of pulmonary M. Avium complex (MAC) disease--: in contrast with survived cases followed-up for 5 years or longer].

We performed a clinical study of pulmonary M. avium complex (MAC) disease comparing decreased cases and survived cases followed-up for 5 years or longer. The results were as follows: 1. At the time of starting the initial medical treatment for pulmonary MAC disease, the deceased cases were older than the survived cases, and the deceased cases were severe than the survived cases in clinical conditions. The spread of the lesions was more extensive and cavities were more frequently observed in the deceased cases than in the survived cases. 2. We classified the clinical pattern of pulmonary MAC disease into a primary infection type and a secondary infection type. Then, we subclassified the primary infection type into a localized type, which contained a tuberculosis-like type and middle, lingular or other lobar pneumonia type, and a diffuse type. The secondary infection type was more frequent in the deceased cases than in the survived cases, and any middle, lingular or other lobar pneumonia type was not observed in the deceased cases. 3. We classified the mode of progression of pulmonary MAC disease in the deceased cases into a tuberculosis-like progression and a diffuse progression. The tuberculosis-like type and the secondary infection type frequently showed the tuberculosis-like progression and the diffuse type frequently showed the diffuse progression. The patients who showed the tuberculosis-like progression were frequently sputum culture positive for MAC, while all patients showing the diffuse progression were culture negative at the time of death. An interval from the estimated onset of the disease to death was shorter in the tuberculosis-like progression type than in the diffuse progression type.

A case of extrapleural empyema.

A 49-year-old man with diabetes mellitus and alcoholic liver cirrhosis presented with dyspnoea and fever. A chest computed tomography scan revealed three areas of loculated pleural effusion. Initially, the patient was thought to have an intrapleural empyema and was treated with intravenous antibiotics and closed drainage. However, as he did not improve, he was then treated with open drainage. During open drainage, the patient was diagnosed to have an extrapleural empyema and improved following open drainage treatment.