肺非結核性抗酸菌症の診断と治療 : 肺結核との相違点と非典型例を中心に

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  • キョウジュ シュウニン キネン コウエン ハイ ヒケッカクセイ コウサンキンショウ ノ シンダン ト チリョウ : ハイケッカク ト ノ ソウイテン ト ヒテンケイレイ オ チュウシン ニ
  • Diagnosis and Treatment of Pulmonary Nontuberculous Mycobacterial Disease : Focusing on Differences from Pulmonary Tuberculosis and Atypical Cases

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In public hospital peer groups such as the National Hospital Organization (NHO) and JA Welfare Federation, hospitals are set up in various places around Japan and play an important role in clinical researches including clinical trials on a nationwide scale. In particular, NHO has contributed to policies such as vaccination against new viruses by conducting clinical studies that are directly linked to medical administration. NHO is also conducting clinical researches to promote EBM in Japan and organ-specific network researches. Many multi-institutional joint studies on pulmonary mycobacterial disease are also underway, and in recent years the weight of research on pulmonary nontuberculous mycobacterial disease (PNTMD) has increased rather than pulmonary tuberculosis (PTB). Epidemiological studies of PNTMD in Japan have been conducted mainly by joint research groups of the former National Sanatorium (now NHO), but with the increase in prevalence, they are now a national survey with the additional participation of community hospitals. The incidence rate of PNTMD in Japan is exceeding that of culture-positive PTB and the highest among major industrialized nations. Although the typical clinical course and radiological manifestations of PNTMD differ from those of PTB, physicians with little experience in treating tuberculosis patients sometimes confuse these mycobacterial diseases. This review describes the diagnosis and treatment of PNTMD, with an emphasis on differences from pulmonary tuberculosis. In addition, I present our own cases of PNTMD at NHO Kochi Hospital and explain the atypical cases and pitfalls that may be encountered in daily practice.

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