Six cases of chronic tenosynovitis of the hand due to the Mycobacterium terrae complex were identified. All isolates from the six cases were identified as Mycobacterium nonchromogenicum by high-performance liquid chromatography and by testing for susceptibility to ofloxacin and to 5% NaCl. Ethambutol, sulfonamides (or trimethoprim-sulfamethoxazole), erythromycin, and streptomycin are the drugs most active against isolates of the M. terrae complex, and therapy with some combination of these agents plus surgical debridement offers the best current treatment of this disease. This study supports the contention arising from previous case reports of pulmonary disease that M. nonchromogenicum is the pathogenic member of the M. terrae complex.

Adult↗

PubMedDate not supplied

Some considerations regarding the classification and identification of mycobacteria.

The principles of classification and identification of microorganisms are stated briefly. Reliable classification and identification are achieved by numerical methods. A simple method of testing the distinctness of taxa (clusters or species) involves three steps: determination of the hypothetical median or mean organism (HMO) for each taxon, estimation of matching coefficients (M values) for individual strains of each taxon to the HMO of the same taxon and to HMOS of other taxa, and definition of the range of a taxon as M +/- 2SD, where M is the mean M value to the HMO. The minimal number of characteristics needed for reliable classification is greater than 40, and none of the characteristics should be related or biased. A species should be defined by more than four strains. After distinct taxa are defined and named as species, new isolates are tested to determine which taxon they belong to. This test is done by a numerical method: comparison of a new isolate with the HMO of various species and testing whether the resulting M values fall within the ranges of any of these species. If an M value of a new isolate falls within the range of taxon X and M values to the HMOS of other species are outside the limits of those species, the isolate is identified as belonging to taxon X. A simple, conventional (nonnumerical) identification system consisting of a small number of tests may be used in clinical laboratories, but one should always keep in mind that identification by such a system often leads to misidentification. Causes of misidentification are false reactions (misjudgment of results), inadequate choice of test characteristics, and use of too small a number of tests.

Diagnostic Errors↗

PubMedDate not supplied

A review of the methods of identification and differentiation of mycobacteria.

Tests reported to be useful for the differentiation of species or groups of mycobacteria are reviewed. Some systems of identification of these organisms are composed of relatively small or large numbers of tests. These systems remain at present "national" identification systems; no "international" system agreed on by scientists worldwide exists. Such an international system is desirable.

Bacteriological Techniques↗

PubMedDate not supplied

Epidemiologic studies of lung disease due to mycobacteria other than Mycobacterium tuberculosis in Japan.

The incidence of lung disease due to mycobacteria other than Mycobacterium tuberculosis (atypical mycobacteria) in Japan was estimated to be 0.9--1.9 per 10(5) population per year in 1971--1979. Although the incidence of lung tuberculosis is steadily decreasing, the incidence of lung disease due to atypical mycobacteria has remained at almost the same level. The number of patients newly infected per year in recent years was calculated to be approximately 2,000. The ratio of the number of patients with lung disease due to atypical mycobacteria to the number of patients with lung disease due to atypical mycobacteria to the number of patients with lung disease due to all species of mycobacteria was highest in hospitals on the southwest coast of the Pacific. The atypical mycobacteria that caused disease most frequently belonged to the Mycobacterium avium-intracellulare complex. Of the 537 cases of disease due to atypical mycobacteria, 491 (89.6%) were due to these organisms; 43 (8.0%), to Mycobacterium kansasii; and 7 (1.3%), to Mycobacterium fortuitum. The disease due to M. kansasii appeared most frequently in hospitals in the Tokyo and Kanagawa prefectures. Patients with lung tuberculosis had a high risk of lung infection due to M. avium-intracellulare. The incidence of such disease in tuberculous patients was estimated to be 18.7 per 10(5) population per year, a rate that is approximately 10 times that found in the general population.

Humans↗

PubMedDate not supplied

Enzyme-linked immunosorbent assay for the differential diagnosis of pulmonary tuberculosis and pulmonary diseases due to Mycobacterium avium-intracellulare complex.

We studied the usefulness of antibody estimation by the enzyme-linked immunosorbent assay (ELISA) technique in the differential diagnosis of pulmonary mycobacterial diseases. Sera from patients with active pulmonary diseases caused by Mycobacterium tuberculosis (n = 42) or Mycobacterium avium-intracellulare complex (MAI) (n = 26) and from healthy controls (n = 75) were assayed for IgG and IgA antibody titers to antigen of M. tuberculosis and MAI. The IgG and IgA antibody titers to M. tuberculosis antigen were significantly higher in patients with mycobacterial diseases than in healthy controls, however, there was no significant difference between patients with pulmonary tuberculosis and those with pulmonary diseases due to M. avium-intracellulare complex (MAID). The IgG and IgA antibody titers to MAI antigen in MAID patients were significantly higher than in healthy controls and in patients with pulmonary tuberculosis. ELISA for IgG antibody against M. tuberculosis antigen had a sensitivity of 54.8% and a specificity of 73.1% in the differential diagnosis of pulmonary tuberculosis. The estimation of the IgA antibody against MAI antigen using ELISA is more useful for the differential diagnosis of MAID because of its sensitivity (69.2%) and specificity (90.5%).

Adult↗