[Japanese new guidelines for nontuberculous mycobacterial pulmonary disease]

Three important statements for Japanese pulmonary nontuberculous mycobacteriosis (NTM) were published in 2008. The first one is a new diagnostic criteria for pulmonary NTM, which was organized in association with the task force for nontuberculous mycobacteriois of the Japanese Society for Tuberculosis and the section for infectious disease and tuberculosis of the Japanese Respiratory Society. The second is a treatment guideline for pulmonary nontuberculous mycobacteriosis also which was made by the same joint working. The third is a sugical treatment guideline for pulmonary nontuberculous mycobacteriosis. The reason for the task of immediate importance is the number of pulmonary Mycobacterium avium complex (MAC) disease keeps increasing in our country and the disease cannot be disregarded widely in municipal hospitals or clinics. The morbidity rate of pulmonary MAC disease is assumed to be about 3.5 in the north American area. A lot of European nations are presumed that do not reach 1.0. Most of Asian researchers reply to our E-mail questions with the recent increasing of pulmonary MAC disease. Japanese estimated morbidity rate of this disease seems to be over 6.0 in 2007. It has been not clarified why a lot of this disease cases are in particular in Japan. In this situation, a concise diagnostic criteria is required from even a doctor who is not respiratory medicine specialists. The diagnosis can be confirmed by twice culture from sputa or one culture in case of bronchoscopic examination regardless of the bacterial strain. Moreover, it is possible to correspond to wider varieties of radiographic findings than 2007 diagnostic criteria of the United States. This disease became possible to diagnose before the consciousness syndrome appeared by the advancement of today's excellent imaging technology and nuclear acid amplification method. Therefore, the diagnosis confirmation and the beginning of chemotherapy time has become separated. In 2008, on Japanese medical insurance, the prescription of two drugs has become possible officially for pulmonary NTM due to the efforts of many stakeholders. However, pulmonary NTM is a disease to obtain a constant improvement at last continuing combination chemotherapy for a long term. Three drugs regiment of CAM as a main axis, adding EB, RFP or RBT is now a de facto international standard. New Japanese guideline for treatment describes the adverse events by a long-term administering more in detail than the previous one. However, it is difficult to control only by an internal therapy. In case of a localized lesion, we have recommended an appropriate surgical treatment. But a surgery treatment without combination of chemotherapy could not achieve an enough result. A multidisciplinary approach is important. The guideline of surgical treatment that reflected these content was also published in 2008.