Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis

Abstract

Background: While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies. Objectives: The purpose of this study was to clarify the clinical features and treatment outcomes of pulmonary NTM infection cases accompanied by NTM pleuritis. Methods: Medical records of 1,044 patients with pulmonary NTM disease were retrospectively reviewed to select patients complicated by NTM-proven pleuritis. We investigated clinical characteristics, pathogens, pleural effusion examinations, radiographic findings, treatments, and clinical course of the NTM pleuritis patients. Results: Among 1,044 cases with pulmonary NTM, NTM pleuritis occurred in 15 cases (1.4%). The mean age was 69 years with a performance status of mostly 2 or better (80.0%), and 6 cases (40.0%) were complicated by pneumothorax. Subpleural cavities were radiologically detected in 11 cases (73.3%), and extrapulmonary air-fluid level was detected in 14 cases (93.3%). Eleven patients were treated with combinations of 2–4 antimycobacterial drugs, including clarithromycin, and 2 patients were treated with isoniazid, rifampicin, and ethambutol. Chest tube drainage was performed in 11 cases, and surgical approach was added in 6 cases. The pleural effusion of 2 patients treated with only antimycobacterial medications gradually deteriorated. Two patients died from NTM pleuritis, and 1 patient died from pneumonitis during a mean of 1.8 years of follow-up. Conclusions: Comorbid NTM pleuritis was difficult to treat by medical therapy alone and resulted in a poor prognosis. In addition to antimycobacterial agents, chest tube drainage and surgical procedures in the early stages should be considered to treat NTM pleuritis.

Clinical Relevance and Characteristics of Nontuberculous Mycobacterial Pleuritis

“…Korea reported that 1.2% of patients from whom NTM had been isolated from sputum had confirmed or suspected NTM pleuritis. Ichiki et al (21) reported that the frequency of PE in patients with pulmonary NTM was 3.4%, Takahiro Ando et al (8) reported that the frequency of PE in patients with pulmonary NTM was 1.4%. In our report, 7% of cases with NTM diseases developed pleuritis with NTM isolated from PE.…”

“…Therefore, the prevalence of NTM pleurisy has become a clinical concern. Moreover, it was reported that the presence of pleural effusion (PE) in NTM patients was considered as an adverse prognostic factor (8)(9)(10). Until now, few studies were performed to evaluate the clinical-pathological characteristics, treatment and prognosis of NTM pleurisy.…”

Life-threatening Mycobacterium intracellulare pleuritis in an immunocompetent host

“…Ando et al reported 15 cases (1.4%) of NTM pleuritis among 1044 patients with NTM lung disease. [ 6 ] Park et al demonstrated 14 patients with NTM pleuritis in a 17-year retrospective study of the data of a single tertiary hospital. [ 7 ] Naito et al and Yoon et al reported retrospective data of 12 patients over 15 years and 5 patients over 13 years in a single center each.…”

Varying clinical presentations of nontuberculous mycobacterial disease : Similar to but different from tuberculosis

“…On the other hand, primary NTM pleurisy (i.e., without distinct pulmonary involvement) is rare, probably because NTM are environmental mycobacteria inducing desensitization in hosts before its infection (53). NTM pleurisy may be caused by a direct extension of infection from pulmonary lesions into the pleural cavity and is often intractable (54)(55)(56). Endoscopic examination to diagnose PNTMD was reported to cause NTM pleuritis with pneumothorax probably due to the rupture of a subpleural lesion during the procedure (20, 57).…”