A prospective study of lung disease caused by Mycobacterium avium/Mycobacterium intracellulare.

This is a prospective study of 36 patients with lung infections caused by M. avium/M. intracellulare. The division of the patients into 2 prognostic groups ("good"/"others"), and the guidelines for their treatment are based on a previous report (3). The criteria for the division were co-existing lung disease and dyspnoea on admittance. The patients in group "good" were treated with isoniazid, rifampicin and ethambutol, in group "others" these were supplemented with one or more drugs. As in the previous study (3), the prognosis was far better for group "good" than for group "others". The patients in group "good" should be treated with isoniazid, rifampicin and ethambutol, unless the course of disease is unsatisfactory. The mortality was high in group "others" and half of the deaths were related to mycobacteriosis. Some patients became culture negative and others showed decreasing numbers of bacteria, but the value of the supplementary drugs could not be proven.

Tuberculosis treated with rifampicin, ethambutol and isoniazid: Danish tuberculosis trial 1972-1974.

A total of 577 Danish patients with tuberculosis were observed for a period of 5 years. A primary phase of treatment with 300 mg Isoniazid (INH), 450 mg Rifampicin (RMP) and 1200 mg Ethambutol (EMB) daily for 3 months was followed by administration of either INH+RMP or INH+EMB for 12 or 18 months after conversion. During the initial period the number of bacteria decreased rapidly, even in patients with the most severe tuberculosis, and all patients became culture negative. There was no significant difference in efficacy of RMP and EMB in the secondary phase. One of the 577 patients again became positive during the follow-up period, but there were no bona fide cases of relapse among patients who completed the treatment.

Lung disease caused by Mycobacterium avium/Mycobacterium intracellulare. An analysis of Danish patients during the period 1962-1976.

The present work is a retrospective study in which the case histories of 37 Danish patients with lung infections caused by M. avium/M. intracellulare are analysed. The result of the chemotherapy used, in some cases combined with surgery, was not satisfactory, since the infection became inactive in 11 patients only. One further patient became negative spontaneously. Prognosis studies for various groups of patients were made by statistical analysis of the collective material. The analysis revealed that co-existing lung disease, dyspnoea on admittance and three other features showed positive mutual correlation, and that the two first-named features were significant prognostic criteria. It is proposed that patients without these features should form a separate group with good prognosis, in which less intensive chemotherapy can be employed, i.e. with the three drugs INH, RMP and EMB. Continuation of this treatment beyond 4 months must depend on the bacteriological response and the clinical condition. For the remaining patients, multidrug therapy (with five drugs) is recommended as soon as the diagnosis is established.

Aquarium-borne Mycobacterium marinum granulomas.

Mycobacterium marinum was isolated for the first time in Denmark from skin granuloma of a 37-year-old man. The skin lesion was provoked by an injury from the broken glass of an aquarium used for tropical fish. Treatment with rifampicin and ethambutol was successful. At the time of diagnosis, M. marinum was also isolated from a dead fish; but in no case was skin granuloma found among purchasers of fish supplied by the patient.

Fatal BCG infection in an immunocompetent girl.

A 6-year-old girl developed progressive symptoms of increased intracranial pressure starting 5 months after BCG vaccination. Thirteen months later craniotomy revealed an epithelioid cell granuloma of the arachnoid occluding the foramen of Magendie. No tubercle bacilli were found on histological examination. Insertion of a Pudenz shunt relieved the symptoms. Six months later generalized BCG infection developed, and in spite of treatment with ethambutol, rifampicin and isoniazid for 10 weeks, death occurred during an episode of increased intracranial pressure. Mycobacterium BCG could be cultured from several organs. The patient showed no obvious evidence of immuno-deficiency as judged on the basis of previous disease history, particle concentration of granulocytes, B and T lymphocytes in peripheral blood, concentration of immunoglobulins in serum, response of lymphocytes to transformation with mitogens and antigens, and histological findings in the thymus and BCG granulomas.

Pulmonary tuberculosis due to BCG in a technician employed in a BCG laboratory.

X-ray examination of the lungs of a laboratory technician in the BCG Department of the Statens Seruminstitut, Copenhagen revealed a lung tumour and possible signs of tuberculosis. The diagnosis was confirmed by macroscopic and histopathological examination of lung tissue removed by surgery. Subsequent bacteriological examination showed the infection to have been caused by BCG. The possibility is discussed of whether the condition had developed from a metastatic lesion following BCG vaccination, or was the result of an aerogenic infection during the production of BCG vaccine. The simultaneous development of the tuberculous condition and the tumour is remarkable but is not discussed further. The requirements of WHO when signs of tuberculosis are found in a worker in a BCG laboratory were complied with in this instance, but it was not considered necessary to change the routine procedure in the BCG Department.