Atypical mycobacteria causing pulmonary disease: rapid diagnosis using skin test profiles

Purified protein derivatives (PPDs) prepared from M tuberculosis (PPD-S), M kansasii (PPD-Y), M scrofulaceum (PPD-G), M avium (PPD-A), M intracellulare (PPD-B), and M fortuitum (PPD-F) were used simultaneously as skin tests to elicit profiles of reactivity in patients with clinical pulmonary disease roentgenologically suggestive of mycobacteriosis. These profiles were useful in delineating the specific cause of mycobacterial disease weeks before bacteriologic confirmation by culture, and they provided a basis for early treatment. When bacteriologic confirmation was attained, the diagnosis suggested by skin testing was correct. Treatment regimens for non-M tuberculosis (atypical) mycobacterial disease varied: a two- to three-drug regimen in the treatment of M avium or M intracellulare disease was ineffective and inappropriate, whereas a five-drug regimen without surgical excision of residual disease produced good results. Combining surgical resection with the five-drug regimen before and after operation produced the best results, however, with all patients showing apparent cure.