title: A Laboratory-based Analysis of Nontuberculous Mycobacterial Lung Disease in Japan from 2012 to 2013.
abstract: BACKGROUND
  Since 2010, mycobacterial examination results have been used widely to survey nontuberculous mycobacteria (NTM) lung disease.
  
  
  OBJECTIVE
  To reveal the clinical and epidemiological status of NTM lung disease in Japan.
  
  
  METHODS
  All data on the isolation and identification of mycobacteria in 2012 and 2013 were obtained from three dominant commercial laboratories in Japan. Pulmonary NTM disease was defined on the basis of bacteriological diagnostic criteria issued by the American Thoracic Society/Infectious Diseases Society of America. The coverage population was estimated using the ratio between national tuberculosis registration data and laboratory results for each of the eight regions of Japan.
  
  
  RESULTS
  A total of 113,313 mycobacterial specimens from 4,710 institutes were collected, and specimens from 26,059 patients tested positive for NTM cultures at least once. Among patients with positive cultures, 7,167 (27.5%) satisfied the American Thoracic Society/Infectious Diseases Society of America criteria for NTM lung disease, resulting in a 2-year prevalence rate of 24.0 per 100,000. Mycobacterium avium complex (MAC) was the most commonly isolated species (93.3%), and 29.0% of the patients from whom MAC was isolated satisfied the criteria for NTM lung disease. Individuals older than 70 years of age accounted for the majority of cases, and 65.5% of cases involved females. After MAC, Mycobacterium kansasii and Mycobacterium abscessus exhibited the highest (43.6%) and second-highest (37.1%) incidence per isolation, respectively. The prevalence of M. kansasii was highest in the Kinki region (P < 0.05), and M. abscessus had the greatest prevalence in the Kyushu-Okinawa region (P < 0.005). The proportion of Mycobacterium intracellulare in MAC cases was higher in the southwestern part of Japan than in other regions. The period prevalence was highest in the southwestern part of Japan, and the standardized prevalence ratio was highest in central regions. Evaluations of clarithromycin susceptibility revealed a clear binomial distribution.
  
  
  CONCLUSIONS
  This investigation is the first laboratory-based study in which a large number of NTM isolated from clinical samples in Japan have been assessed. Although the calculated prevalence of NTM disease might be underestimated, the approach may prove useful for monitoring relative epidemiological data for NTM lung disease.
authors: 1 Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors: Kozo
authors: http://orcid.org/0000-0002-8239-9275
authors: K
authors: Morimoto
authors: 2 Center for Infectious Diseases and Infection Control and.
authors: Naoki
authors: N
authors: Hasegawa
authors: 3 Department of Epidemiology and Clinical Research and.|4 Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Kiyohiko
authors: K
authors: Izumi
authors: 5 Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.|6 Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan.
authors: Ho
authors: http://orcid.org/0000-0001-6181-4284
authors: H
authors: Namkoong
authors: 3 Department of Epidemiology and Clinical Research and.
authors: Kazuhiro
authors: K
authors: Uchimura
authors: 1 Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors: Takashi
authors: T
authors: Yoshiyama
authors: 7 Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Yoshihiko
authors: Y
authors: Hoshino
authors: 1 Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
authors: Atsuyuki
authors: A
authors: Kurashima
authors: 8 SRL, Inc., Tokyo, Japan.
authors: Jun
authors: J
authors: Sokunaga
authors: 9 LSI Medience Corporation, Tokyo, Japan.
authors: Shunsuke
authors: S
authors: Shibuya
authors: 10 BML, Inc., Tokyo, Japan; and.
authors: Masahiro
authors: M
authors: Shimojima
authors: 11 Department of Immunology, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Manabu
authors: M
authors: Ato
authors: 12 Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.|4 Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Satoshi
authors: S
authors: Mitarai
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000073358:Mycobacterium abscessus; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy / Q000453:epidemiology; D019909:Mycobacterium kansasii; D015995:Prevalence; D017678:Sex Distribution; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D017291:Clarithromycin
keywords: clarithromycin; epidemiology; nontuberculous mycobacteriosis; prevalence; regional differences