Watanuki Y, Odagiri S, Suzuki K, Takahashi H, Takahashi K, Yoshiike Y, Ogura T, Shoji A, Nishiyama H, Toda M, Tomioka T
Department of Respiratory Disease, Kanagawa Cardiovascular and Respiratory Diseases Center, Japan.
Kansenshogaku Zasshi. 1999 Aug;73(8):728-33. doi: 10.11150/kansenshogakuzasshi1970.73.728.
In 14 subjects whose chest radiographs showed abnormal shadows during the two years from January 1995 until December 1996, no definite diagnosis could be obtained because sputum, smears and cultures all gave negative results for mycobacteria. Bronchoscopy was therefore performed, revealing atypical mycobacteria in cultures of the bronchial washing fluid for mycobacteria, and the significance of bronchoscopic examinations in cases diagnosed an atypical pulmonary mycobacteriosis was investigated. Most of the subjects (9) were women. Nine subjects had been informed that they had abnormal chest shadows; five had subjective symptoms; bloody sputum, 3 and cough, 2. The characteristics of the shadows were as follows: in the plain radiographs, the main shadows had a mottled or granular appearance in the majority of the patients (9) and there were infiltrative shadows in 3 patients and nodular shadows in another 3. In computed tomograms, the shadows in the vicinity of the pleura appeared as micronodular conglomerates in 12 patients, in 11 of whom bronchiectasis was also present near the shadows. Alveolar infiltrative shadows were present in four cases, and a cavity was seen in only one. Smears of the bronchial washing fluid for mycobacteria were positive in 7 patients, and cultures of this fluid yielded at least 100 colonies in 8 of the 14 subjects for whom the results were positive. By culture, Mycobacterium avium complex (MAC) was identified in 13 patients, but eleven of these in whom the bronchial washing fluid was concurrently tested for MAC by the polymerase chain reaction, only four were MAC-positive. Transbronchial lung biopsies were performed in 11 cases, in which the histological findings of mycobacterial infections showed granuloma in four, and caseation in three. Bronchoscopy is making possible initial-stage diagnosis, which are normally difficult, among the recently growing number of cases of the bronchial form of atypical pulmonary mycobacteriosis and is also useful for reaching definite diagnosis in the early stage.
在1995年1月至1996年12月这两年间，14名胸部X光片显示异常阴影的患者，由于痰液涂片和培养的分枝杆菌结果均为阴性，未能获得明确诊断。因此进行了支气管镜检查，在支气管灌洗液体的分枝杆菌培养中发现了非典型分枝杆菌，并对支气管镜检查在非典型肺部分枝杆菌病诊断中的意义进行了研究。大多数患者（9名）为女性。9名患者被告知胸部有异常阴影；5名有主观症状，其中3名有血痰，2名有咳嗽。阴影特征如下：在普通X光片中，大多数患者（9名）的主要阴影呈斑点状或颗粒状，3名患者有浸润性阴影，另外3名有结节状阴影。在计算机断层扫描中，12名患者胸膜附近的阴影呈微结节状聚集，其中11名患者阴影附近还存在支气管扩张。4例有肺泡浸润性阴影，仅1例有空洞。7名患者的支气管灌洗液体分枝杆菌涂片呈阳性，14名结果为阳性的患者中有8名该液体培养产生至少100个菌落。通过培养，在13名患者中鉴定出鸟分枝杆菌复合群（MAC），但其中11名同时通过聚合酶链反应检测支气管灌洗液体中的MAC，只有4名呈MAC阳性。11例患者进行了经支气管肺活检，其中4例的分枝杆菌感染组织学表现为肉芽肿，3例为干酪样坏死。支气管镜检查使得在近期不断增加的支气管型非典型肺部分枝杆菌病病例中进行通常困难的早期诊断成为可能，并且对于早期明确诊断也很有用。
