We studied whether the serotypes of Mycobacterium avium-Mycobacterium intracellulare complex (MAC) isolates determine the prognosis for pulmonary MAC disease. We prospectively monitored a cohort of 68 patients with pulmonary MAC disease for whom the serotype-specific glycopeptidolipids in isolates were identified using thin-layer chromatography and fast atom bombardment mass-spectrometry in 1990 and 1995. Serovar 4 Mycobacterium avium was detected in 40/68 patients (58.8%). Other serotypes were serotypes 1 (five cases), 6 (three cases), 8 (seven cases), 9 (three cases), 14 (four cases), and 16 (six cases). Patients with serovar 4 were significantly (P < 0.01) younger (63.0 ؎ 9.8 years) than patients with other serotypes (71.8 ؎ 10.3). Patients who failed treatment had a significantly poorer prognosis than other patients. There were no cases of MAC-related death in the cured group. Chest radiographic findings progressively worsened in 36 (90%) of patients with serotype 4, and 14/36 died from respiratory failure caused by pulmonary Mycobacterium avium disease. The patients with serotype 4 had a significantly poorer prognosis than patients with other serotypes. These results show that both the outcome of chemotherapy and the serotypes of MAC isolates are important for assessing the prognosis of pulmonary MAC disease.

We have prospectively analyzed three antigens for serodiagnosis of tuberculosis (TB). These antigens were tuberculous glycolipid antigen, lypoarabinomannan polysaccharide antigen, and antigen 60 (A60), which was derived from purified protein derivatives. Of the 131 patients with active pulmonary TB, 57 were both smear and culture negative and 14 had chronic active pulmonary TB that remained smear positive for >12 months of chemotherapy. One hundred twenty healthy adults were controls. The percentages of patients positive in all three tests were 58.8% for smear-positive active pulmonary TB and 71.4% for chronic active pulmonary TB. When the results of the three serodiagnostic tests were evaluated in combination, the sensitivity increased to 91.5% in patients with active pulmonary TB and to 86.0% in smear-and culture-negative patients. The false-positive rate of the three-test combination was 12.5% in the healthy control groups. In conclusion, it was not possible to detect all of the antibodies against antigenic substances in the cell walls of the tuberculous bacilli in the sera of all TB patients by using available serodiagnostic tests. However, the combined use of tests with three separate antigens maximizes the effectiveness of serodiagnosis.Arloing described the first serodiagnostic test for tuberculosis (TB), which used hemagglutination, in 1898 (2), but since then progress in serodiagnosis has been slow. In the last decade, studies of new assays that use various antigens (7,10,11,12,18,20) for measurement of serum antibodies to Mycobacterium tuberculosis in patients with TB have been reported. Enzyme-linked immunosorbent assay (ELISA)-based serological tests to detect antibodies to M. tuberculosis are simple and inexpensive and are a potentially practical tool for the diagnosis of active pulmonary TB. However, almost all of the assays are limited by sensitivity, especially in smear-negative TB patients. An additional limitation is the variability in sensitivity, depending on both the investigator and the geographic origin of the survey participants (5, 15). However, the reported specificity of Ͼ90% is acceptable for a serodiagnostic test (7,10,11,12,18,20).Previously, the development of a rapid diagnostic ELISA for TB that is specific for antibodies to antituberculous glycolipid (anti-TBGL) was reported (17). The combined use of trehalose-dimycolate and minor glycolipids in the TBGL assay, rather than purified trehalose-dimycolate alone, results in increased diagnostic sensitivity for TB (13). The cell wall antigen composition of each patient isolate of tuberculous bacilli differs, resulting in antibodies with different specificities among patients (4, 9). We hypothesized that the TB patient does not produce antibodies against all antigenic substances in the cell wall of the tuberculous bacilli and that the specificities of the antibodies differ among patients. Consequently, the use of more than a single antigen would improve the sensitivity of serodiagnosis for active pulmonary TB. In order to test these hy...