In recent years, many novel nontuberculous mycobacterial species have been discovered through genetic analysis. Mycobacterium massiliense and M. bolletii have recently been identified as species separate from M. abscessus. However, little is known regarding their clinical and microbiological differences in Japan. We performed a molecular identification of stored M. abscessus clinical isolates for further identification. We compared clinical characteristics, radiological findings, microbiological findings, and treatment outcomes among patients with M. abscessus and M. massiliense lung diseases. An analysis of 102 previous isolates of M. abscessus identified 72 (71%) M. abscessus, 27 (26%) M. massiliense, and 3 (3%) M. bolletii isolates. Clinical and radiological findings were indistinguishable between the M. abscessus and M. massiliense groups. Forty-two (58%) patients with M. abscessus and 20 (74%) patients with M. massiliense infections received antimicrobial treatment. Both the M. abscessus and M. massiliense groups showed a high level of resistance to all antimicrobials, except for clarithromycin, kanamycin, and amikacin. However, resistance to clarithromycin was more frequently observed in the M. abscessus than in the M. massiliense group (16% and 4%, respectively; P ‫؍‬ 0.145). Moreover, the level of resistance to imipenem was significantly lower in M. abscessus isolates than in M. massiliense isolates (19% and 48%, respectively; P ‫؍‬ 0.007). The proportions of radiological improvement, sputum smear conversion to negativity, and negative culture conversion during the follow-up period were higher in patients with M. massiliense infections than in those with M. abscessus infections. Patients with M. massiliense infections responded more favorably to antimicrobial therapy than those with M. abscessus infections. Mycobacterium species are common causes of pulmonary infections in both humans and animals (14). Although members of the Mycobacterium tuberculosis complex cause the majority of pulmonary infections worldwide, many nontuberculous mycobacteria (NTM) can cause similar infections (13,20). In recent years, many novel NTM species have been discovered through the increased application of genetic investigation tools; detailed genetic characterizations have helped define new taxonomic groupings (17,29). Recently, two new M. abscessus-related species, M. massiliense and M. bolletii, were identified, which were previously grouped with M. abscessus (1, 3). The rate of isolation of these two species has been increasing in Japan. However, very little is known about the natural epidemiology and pathogenicity of M. massiliense and M. bolletii outside outbreak situations. One report found that the ratio of M. abscessus to all NTM is much higher in South Korea (19) than in other countries, including Japan.Here, we aimed to evaluate the epidemiology, clinical and radiological spectrum, treatments, drug susceptibility, and outcome of M. abscessus and M. massiliense lung diseases during therapy in Japan. MATERIALS AND ME...

Objective The aim of this study was to clarify the association between nutritional state on admission and in-hospital death in tuberculosis (TB) patients, including a high proportion of elderly patients. Methods A retrospective cohort study of 246 TB patients was conducted. The serum albumin concentrations and peripheral blood lymphocyte counts were measured on admission, and the primary outcome of interest was in-hospital death. Patient mortality was categorized into two groups: TB death and non-TB death. A multivariate analysis was performed to evaluate the relationship between nutritional state on admission and in-hospital mortality in TB patients. .015) on admission were significantly associated with all in-hospital deaths in the TB patients. The serum albumin concentrations and peripheral blood total lymphocyte counts were also found to be associated with in-hospital deaths directly caused by TB. Conclusion Hypoalbuminemia and lymphocytopenia on admission are predictive risk factors for in-hospital mortality in TB patients. Nutritional defects should thus receive special attention in order to reduce TB patient mortality, particularly among elderly patients.

We present a case of pulmonary sarcoidosis showing the "reversed halo sign" on high-resolution computed tomography (HRCT). A 27-year-old man presented with nonproductive cough and high fever lasting for 3 weeks. A chest radiograph showed multiple areas of consolidation and cavitary shadows in the lungs. The HRCT showed the reversed halo sign, a central ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation. Moreover, miliary nodules were observed in the central ground-glass opacity areas and around the outer areas of consolidation. The HRCT also showed a large nodule, subpleural nodules bordering the costal pleural surfaces, and interlobular fissure. Transbronchial biopsy was performed, and the histopathologic features were those of sarcoidosis and without cryptogenic organizing pneumonia.

Volume 50, no. 11, p. 3556 -3561, 2012