Clinical characteristics of patients with bronchiectasis with nontuberculous mycobacterial disease in Mainland China: a single center cross-sectional study

Abstract

Background The diagnosis and treatment of patients with bronchiectasis and nontuberculous mycobacterium (NTM) pulmonary disease are challenging issues and the treatment is also prolonged and depends on the species. There is limited information on patients with bronchiectasis and NTM pulmonary disease in Mainland China. Methods This cross-sectional study was conducted at the China–Japan Friendship Hospital, Beijing, China. Those adult patients who met the diagnostic criteria for bronchiectasis and obtained a culture result of mycobacteria from lower respiratory tract specimens or lung tissue were included in this study. A logistic regression model was used to identify the related factors in patients with NTM pulmonary disease. Results A total of 202 patients with bronchiectasis from 19 cities, 155 without and 47 (23.3%) with NTM pulmonary disease, were included. In all the 47 patients with NTM pulmonary disease, Mycobacterium avium complex was the most common species (66.0%), and 72.3% of them were initiated on standard anti-NTM treatment within 3 months after the diagnosis of NTM pulmonary disease. A larger proportion of patients with NTM pulmonary disease had acute exacerbations of ≥ 3 times within 1 year and were diagnosed bronchiectasis ≥ 50 years among patients with NTM pulmonary disease. The HRCT chest images revealed higher proportions of nodular shadow (100% vs. 35.3%), tree-in-bud sign (97.9% vs. 29.0%), cavities (29.8% vs. 5.8%), and airway dilation of the right middle lobe or the left lingular lobe (63.8% vs. 23.9%) in patients with NTM pulmonary disease than in those without NTM pulmonary disease (all P values = 0.001). The multivariable logistic regression model indicated that three and more abnormal features (OR 33.8; 95% CI 11.1–102.8) and main lesions of bronchial expansion in the middle or lingual lobe (OR 6.4; 95% CI 2.4–16.6) in HRCT chest images were independently associated with NTM pulmonary disease (P values = 0.001). Conclusion In a single center of Mainland China, > 23% of patients with bronchiectasis had NTM pulmonary disease, and most patients were started on standard treatment within 3 months after the diagnosis of NTM pulmonary disease. These findings suggest that patients with bronchiectasis should be thoroughly examined for the presence of NTM pulmonary disease. Trial registration NCT03594032.

Phenotypical characteristics of nontuberculous mycobacterial infection in patients with bronchiectasis

“…Similarly, the association of lower BMI with NTM pulmonary infection has been previously reported [ 11 , 12 , 19 , 21 ]. While lower BMI may simply be a result of the NTM infection itself, it has been suggested that decreased fat mass with corresponding regulatory dysfunction of adipokines that participate in the immune response, such as leptin and adiponectin, may increase susceptibility to NTM infection [ 21 , 22 ].…”

“…Patients with NTM pulmonary infection are generally characterized by older age [ 11 – 13 , 19 ] which may entail an age-dependent decrease in respiratory muscle strength and mucocilliary clearance and an association with other factors such as impaired cell-mediated immunity, cytokine production, and phagocytosis [ 20 ]. The pathophysiologic mechanisms underlying the association of NTM infection and female gender, also reported by others [ 11 , 12 , 21 ], are not fully understood. It is noteworthy that there is a similar gender bias of bronchiectasis in general.…”

“…Patients with bronchiectasis are particularly susceptible [ 8 , 9 ] because their impaired muco-ciliary clearing mechanism inhibits an important natural protective barrier against NTM [ 3 ]. The diagnosis of NTM pulmonary infection based on the clinical presentation alone can be challenging in patients with bronchiectasis owing to the similar pulmonary symptoms to patients without NTM [ 10 , 11 ]. Radiological findings may be instructive, as the presence of NTM pulmonary infection is often associated with more extensive lung involvement [ 10 – 14 ].…”

Organizing pneumonia due to pulmonary non-tuberculosis mycobacteria: a case description and literature analysis

“…There is currently sufficient literature describing the radiological features of NTM. Some features such as thin-walled cavity and bronchiectasis ( 21 , 22 ) in the middle lobes and the left upper lobe are typical NTM imaging features, as are other such as consolidation, GGO, nodules and “tree-in-bud” pattern and so on ( 9 ). However, SOP due to NTM is combined with imaging changes in areas such as near the periphery of LL, and “reversed halo sign” ( 23 ), especially during NTM treatment.…”

The role of volatile organic compounds for assessing characteristics and severity of non-cystic fibrosis bronchiectasis: an observational study

“…The disease is characterized by recurrent cough, sputum production, and respiratory tract infections (1)(2)(3). Bacterial infections trigger an inflammatory response, which further exacerbates airway inflammation and airway structural damage, leading to the well-described "vicious cycle" of bronchiectasis (4,5).…”