Chronic bronchial collapse and lower lobe atelectasis. Computed tomographic-bronchoscopic correlation.

the greater the likelihood of establishing the correct diagnosis. Conversely, when employing invasive diagnostic procedures more often, the risk of complications also increases proportionately. Ultimately, the exact risk-benefit ratio is not known forthis diagnostic strategy. A study much larger and more comprehensive than either ours or that of Cazzadori et al is necessary to definitively answer this question. PrimaryPulmonary Diseasedueto Mycobacterium avium-intracellulare lb the Editor: I read with interest Dr. Reich's report of a case of primary pulmonary disease due to Mycobacterium vi ace ulare 1 article Dr. Reichstatesthat â€oe¿¿ only three cases, all involvingchildren, havebeen reported.†• In August 1984 we reported a case similar to that of Dr. Reich in a 28-month-oldmaleinfant who presentedwith cough,stridor, and wheeze of 3 weeks' duration.2 Bronchoscopy showed a fleshy mass on the anterior wall of the left main bronchus. Acid-fast bacilli were seen on microscopy, but cultures were not done. Later, fasting gastric washingsgrew M avium-intracellulare scrofulaceum(MAIS) on culture. The Mantoux reaction was 8 mm to 10 IU of human tuberculin purified protein derivative (PPD) and 18 mm to 10 IU of avian PPD. An attempt to trace the source produced MAIS on several cultures of composted soil near the patient's house, which was in a rural area. However, the strain was not identical with that cultured from the patient. He made a rapid recovery on a regimen of isoniazid and rifampicin, even though the organism was resistant to these drugs, as well as to streptomycin and ethambutol. REFERENCES 1 Reich JM. Primary pulmonary disease due to Mycobacterium avium-intracellulare. attention. In reviewing his citations and my own, I find that the statement that â€oe¿¿ only three cases [ofprimary pulmonary disease due to M avium complex], all involving children, have been reported†• is erroneous; the correct number is six.'@ Of considerable interest is that his patient, like ours, had avian exposure, as did one oftwo cases reported by Lincoln and Gilbert.l The individual reported by Kelsey et al@resided â€oe¿¿ in a rural area with many domestic farm animals in the vicinity:' No information concerning avian exposure was provided in the two cases reported by Powell and Walker.2 Engbaek@ reported three fatal cases of progressive pulmonary disease due to M avium complex in two siblings and their mother, and indicated that chickens were allowed to wander freely in the kitchen and bedroom. In summary, there is strong circumstantial evidence that domes ticated birds …