A CLINICAL STUDY OF THE CHRONIC LUNG DISEASE DUE TO NONPHOTOCHROMOGENIC ACID-FAST BACILLI

Abstract

This paper describes a clinical study of 116 patients with chronic pulmonary disease due to "atypical" non-photochromogenic mycobacterla, treated in the 4 Florida Tuberculosis Hospitals during a 5-year period. The disease simulated pulmonary tuberculosis in pathological, radiological and clinical manifestations and was encountered more frequently in indiciduals over 40 years of age, predominately white males. There was no instance of its occurrence in more than one member of a family or its transmission to another individual. The majority of patients had coexisting lung disease, especially pulmonary emphysema and tuberculosis. The organisms are acid-fast, grow at room temperature, differ in several cultural features from Mycobacterium tuberculosis, and are nonpathogenic for guinea pigs. Runyon has divided them into groups according to photochromogenicity. The cases reported in this study are nonphotochromogens, predominately honpigmented (Group III-A), but some were pigmented (Group III-B). Differential skin testing with PPD prepared from nonphotochromogens III-A and standard tuberculin resulted in a more strongly positive reaction to the homologous antigen. Patients were chronically ill or asymptomatic on admission. Treatment consisted of isolation, drugs, including isoniazid in an attempt to prevent tuberculosis, and 2 other drugs as indicated by susceptibility, together with surgery in appropriate cases. Medical treatment was relatively ineffective with failure of X-ray improvement in 53% and failure of sputum conversion in 43%. Surgery was done in 38 cases and resulted in sputum conversion of 87%. Seventeen patients died, the majority of progressive pulmonary disease. Two patients acquired pulmonary tuberculosis, apparently while hospitalized. Patients should be isolated, treated with isoniazid and 2 additional drugs, together with surgery if indicated, and discharged as soon as maximum hospital benefit is obtained.