<i>Mycobacterium avium</i> complex infection in non‐cystic fibrosis bronchiectasis

Zoumot, Zaid; Boutou, Afroditi; Gill, Simon; Zeller, Mafalda van; Hansell, David M.; Wells, Athol U.; Wilson, Robert; Loebinger, Michael R.

doi:10.1111/resp.12287

Cited by 61 publications

(52 citation statements)

References 21 publications

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“…The largest involving 634 patients with MAC201 demonstrated male gender, age, comorbidity, non-nodular bronchiectatic features, BMI <18.5, anaemia, low albumin and ESR >50 to be associated with all-cause mortality 201. Similar findings relating to low BMI,197 220 cavitatory disease189 197 198 202 and aspergillus coinfection198 were reported in smaller studies involving patients with NTM-PD.…”

Section: Section 11: What Factors Influence When Ntm Treatment Shouldmentioning

confidence: 56%

British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)

Haworth

Banks

Capstick

et al. 2017

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Section: Section 11: What Factors Influence When Ntm Treatment Shouldmentioning

confidence: 56%

British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)

Haworth

Banks

Capstick

et al. 2017

Thorax

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584

679

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mentioning

confidence: 99%

“…CPA usually occurs in middle-aged and elderly patients, for whom the most common underlying disease is pulmonary tuberculosis (6, 7). In addition, there is increasing evidence that nontuberculous mycobacterial (NTM) lung disease is an important underlying condition associated with CPA (7-12), with some patients having CPA and coexisting NTM lung disease (12,13).Mycobacterium avium complex (MAC) is the most common etiology of NTM lung disease (14-16). Rifampin is recommended as part of a multidrug antibiotic regimen for the treatment of MAC lung disease (14-16).…”

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confidence: 99%

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Moon

Park

Jeong

et al. 2015

Antimicrob Agents Chemother

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bWe investigated the effects of rifampin and rifabutin on serum itraconazole levels in patients with chronic pulmonary aspergillosis. Serum itraconazole concentrations were significantly lower in patients who received itraconazole with rifampin (median, 0.1 g/ml; P < 0.001) or rifabutin (median, 0.34 g/ml; P < 0.001) than those receiving itraconazole alone (median, 5.92 g/ml). Concomitant use of rifampin or rifabutin and itraconazole should be avoided in patients with chronic pulmonary aspergillosis and coexisting mycobacterial infections. Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infectious disease secondary to local invasion by a species of Aspergillus, usually Aspergillus fumigatus (1, 2). Although the optimal therapeutic regimen and duration of treatment have not been established, long-term oral itraconazole is currently recommended as the primary treatment for CPA (3-5). CPA usually occurs in middle-aged and elderly patients, for whom the most common underlying disease is pulmonary tuberculosis (6, 7). In addition, there is increasing evidence that nontuberculous mycobacterial (NTM) lung disease is an important underlying condition associated with CPA (7-12), with some patients having CPA and coexisting NTM lung disease (12,13).Mycobacterium avium complex (MAC) is the most common etiology of NTM lung disease (14-16). Rifampin is recommended as part of a multidrug antibiotic regimen for the treatment of MAC lung disease (14-16). Rifampin is a potent inducer of hepatic cytochrome P450 enzymes, which in turn can accelerate the hepatic metabolism of antifungal agents. In this way, rifampin presents a practical challenge for choosing the appropriate antibiotics for treating CPA with coexisting NTM lung disease (17,18). Indeed, previous case reports have demonstrated that concurrent administration of rifampin with itraconazole can greatly reduce serum itraconazole concentrations (19)(20)(21)(22).Rifabutin has less severe drug-drug interactions than does rifampin and is used as a substitute for rifampin in the treatment of tuberculosis and NTM lung disease, especially for patients who are receiving medications that have unacceptable interactions with rifampin, such as antiretroviral agents (14, 23). Nevertheless, there are no published studies that evaluated the interaction between rifabutin and itraconazole. Thus, the objective of the present study was to investigate the effects of rifampin and rifabutin on serum itraconazole levels in patients with CPA and coexisting mycobacterial lung disease.This study was a single-institution retrospective review of 66 patients with CPA who were treated with oral itraconazole (Sporanox, Janssen Pharmaceutica) (200 mg twice daily) and for whom serum itraconazole concentrations were measured between January 2013 and June 2014. Peripheral venous sampling was performed prior to morning itraconazole administration to determine trough concentrations after at least 7 days of treatment.The serum concentrations of itraconazole and hydroxyl-itraconazole we...

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“…CT scoring was performed as previously described [12] by a specialist radiologist with 5 years of experience in thoracic imaging, blinded to clinical details. For bronchiectasis extent, bronchiectasis severity, tree-in-bud opacification, nodules and consolidation, tertiles of the maximum possible score for each feature were used to categorise the features as low, medium or high.…”

Section: Methodsmentioning

confidence: 99%

Latent class analysis to define radiological subgroups in pulmonary nontuberculous mycobacterial disease

et al. 2018

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BackgroundNontuberculous mycobacterial (NTM) pulmonary disease has conventionally been classified on the basis of radiology into fibrocavitary and nodular-bronchiectatic disease. Whilst being of great clinical utility, this may not capture the full spectrum of radiological appearances present. The aim of this study was to use latent class analysis (LCA) as an unbiased method of grouping subjects with NTM-pulmonary disease based on their CT features and to compare the clinical characteristics of these groups.MethodsIndividuals with NTM-pulmonary disease were recruited and a contemporaneous CT scan obtained. This was scored using an NTM-specific scoring system. LCA was used to identify groups with common radiological characteristics. The analysis was then repeated in an independent cohort.ResultsThree classes were identified in the initial cohort of 85 subjects. Group 1 was characterised by severe bronchiectasis, cavitation and aspergillomas, Group 2 by relatively minor radiological changes, and Group 3 by predominantly bronchiectasis only. These findings were reproduced in an independent cohort of 62 subjects. Subjects in Group 1 had a lower BMI and serum albumin, higher serum CRP, and a higher mortality.ConclusionsThese findings suggest that NTM-pulmonary may be divided into three radiological subgroups, and that important clinical and survival differences exist between these groups.Electronic supplementary materialThe online version of this article (10.1186/s12890-018-0675-8) contains supplementary material, which is available to authorized users.

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Mycobacterium avium complex infection in non‐cystic fibrosis bronchiectasis

Abstract: Chronic pulmonary aspergillosis in patients with bronchiectasis and coexisting MAC infection is a strong predictor of mortality. Cavitation within nodules and emphysema on HRCT at presentation were independently associated with mortality.

Cited by 61 publications

References 21 publications

British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)

British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Latent class analysis to define radiological subgroups in pulmonary nontuberculous mycobacterial disease

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