Clinical investigation of pulmonaryMycobacterium avium complex infection in human T lymphotrophic virus type I carriers
- Wataru Matsuyamaa,
- Akira Mizoguchib,
- Fumiyuki Iwamib,
- Yoshifusa Koreedaa,
- Joeji Wakimotob,
- Hironobu Kanazawaa,
- Shinichirou Moria,
- Masaharu Kawabataa,
- Hidetomo Fukunagac,
- Mitsuhiro Osamea
- aThird Department of Internal Medicine, Kagoshima University School of Medicine, Sakuragaoka 8-35-1, Kagoshima, 890-8520 Japan, bDepartment of Respiratory Medicine, National Minami-kyushu Hospital, Kajiki-cho Kida 1882, Aira-gun, Kagoshima, 899-5293 Japan, cDepartment of Internal Medicine, Ariake Medical Association Hospital, Ariake-cho Noikura 8288, Sou-gun, 899-7402 Japan
- Dr W Matsuyama email: vega{at}xaz.so-net.ne.jp
- Received 15 June 1999
- Revision requested 1 September 1999
- Revised 21 December 1999
- Accepted 31 January 2000
Abstract
BACKGROUND Little is known about pulmonary Mycobacterium aviumcomplex (MAC) infection in human T lymphotrophic virus type I (HTLV-I) carriers. A study was undertaken to investigate and clarify the characteristics of pulmonary MAC infection in these subjects.
METHODS Twenty nine patients with pulmonary MAC infection without any underlying pulmonary disorder were investigated. The clinical features and radiographic appearance of HTLV-I carriers and non-carriers were compared and the bronchoalveolar lavage (BAL) fluid of these 29 patients and eight normal female control subjects was analysed.
RESULTS The prevalence of the HTLV-I carrier state in patients with pulmonary MAC infection was 34.5% (10/29) compared with 16.7% (529/3169) among all patients admitted to our department between 1994 and 1998 (odds ratio (OR) 2.63, 95% confidence interval (CI) 1.21 to 5.68). The HTLV-I carriers were all women and all had clinical symptoms, but they did not show systemic dissemination. Peripheral multifocal bronchiectasis with nodular shadowing was seen frequently on the chest computed tomographic (CT) scans of HTLV-I carriers. The area of the pulmonary lesions was more extensive than in non-carriers (p<0.05). White blood cell (WBC) counts and C reactive protein (CRP) levels on admission were significantly lower in HTLV-I carriers than in non-carriers (WBC: difference (D) = 1565/μl, 95% CI –68.9 to 3198.4/μl; CRP: D = 1.8 mg/dl, 95% CI –0.35 to 3.89 mg/dl). The concentrations of neutrophil elastase (NE) and interleukin (IL)-8 in BAL fluid were significantly higher in HTLV-I carriers than in non-carriers (NE: D = 1342 μg/l, 95% CI 704 to 1980.3 μg/l; IL-8: D = 304.5 pg/ml, 95% CI 89.7 to 519.4 pg/ml).
CONCLUSIONS Pulmonary MAC infection causes more diffuse and widespread lesions in HTLV-I carriers than in non-carriers.
