Different clinical features of patients with pulmonary disease caused by various Mycobacterium avium–intracellulare complex subspecies and antimicrobial susceptibility

Abstract

Characteristics of the Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD) caused by distinct subspecies remain uncertain. Methods: This study was conducted from 2013-2015 in three hospitals in Taiwan. Results: Among the 144 patients with MAC-PD, 57 (39.6%), 37 (25.7%), 37 (25.7%), and 13 (9.0%) were infected with Mycobacterium intracellulare subspecies intracellulare (MIsI), Mycobacterium avium subspecies hominissuis (MAsH), Mycobacterium intracellulare subspecies chimaera (MIsC), and others, respectively. Patients with MAsH-PD were younger (p = 0.010) with higher human immunodeficiency virus infection rates (27.0%, 0.0%, 0.0%, and 7.7% for MAsH-PD, MIsC-PD, MIsI-PD, and others, respectively; p < 0.001). Twenty-two (15.3%) patients reported spontaneous culture-negative conversion, but 15 (10.4%) and 33 (22.9%) patients developed radiographic progression and unfavorable outcomes, especially MAsH-PD. The susceptibility rates to clarithromycin and inhaled amikacin were both 98.6%. MAsH demonstrated the lowest rate of resistance to moxifloxacin (66.7%, 97.3%, 89.1%, and 92.3% for MAsH-PD, MIsC-PD, MIsI-PD, and others, respectively; p = 0.001) and MIsI isolates had the highest rate of resistance to intravenous amikacin (25%, 13.5%, 38.2%, and 15.4% for MAsH-PD, MIsC-PD, MIsI-PD, and others, respectively; p = 0.024). Conclusions: Pulmonary disease caused by distinct MAC subspecies had different outcomes and drug susceptibility. The local prevalence of species needs to be monitored.

The factors associated with mortality and progressive disease of nontuberculous mycobacterial lung disease: a systematic review and meta-analysis

“…Total 1,439 patients from 11 studies were included in the review of factors associated with radiographic progressive disease 20 , 30 , 42 – 50 . Figures 4 and S3 present the pooled adjusted RRs and unadjusted RRs, which estimated the association between factors and progressive disease using forest plots.…”

Treatment outcomes and relapse in patients with Mycobacterium avium-intracellulare complex pulmonary disease

“…Low BMI, human immunodeficiency virus, positive smear at the start of treatment, presence of a cavity, and non-guideline-based treatment have been reported as poor prognostic factors for the management of MAC-PD ( 11 , 20 ). Mycobacterium avium and Mycobacterium intracellulare are the two major subspecies, with the latter being more virulent ( 3 ) and may have different treatment outcomes. However, available data are limited.…”

“…All consecutive patients diagnosed with MAC-PD between April 2011 and December 2020 according to the 2020 American Thoracic Society/Infectious Diseases Society of America guidelines ( 24 ) were enrolled. The diagnostic criteria included clinical and microbiological sections as previously described ( 3 ). All antibiotic-naïve participants were treated with anti-MAC medication, judged by clinical physicians according to the severity of MAC-PD, risk of progressive MAC-PD, and presence of comorbidities ( 5 ), and were followed up for 3 years after treatment initiation.…”

“…The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) are increasing ( 1 ), and Mycobacterium avium complex (MAC) is the most common pathogen in Taiwan and worldwide ( 2 , 3 ). Although the mortality rate of MAC-PD is high ( 4 ), determining the appropriate timing of treatment initiation in patients with MAC-PD remains challenging.…”

A novel repeat sequence-based PCR (rep-PCR) using specific repeat sequences of Mycobacterium intracellulare as a DNA fingerprinting

“…MAC includes M. avium, Mycobacterium intracellulare , M. arosiense, M. bouchedurhonense, M. chimaera, M. colombiense, M. marseillense, M. timonense, M. vulneris, and M. yongonense ( Parker et al, 2020 ; Keen et al, 2021 ). Among them, M. intracellulare has been reported to be responsible for the largest proportion of MAC-PD cases ( Prevots and Marras, 2015 ; Chang et al, 2020 ; Ratnatunga et al, 2020 ). Mycobacterium intracellulare can be found in any environment, including soil, water, and air, and molecular epidemiology has revealed considerable genetic variation in its strains ( Hruska and Kaevska, 2012 ; Parker et al, 2020 ; Lari and Rindi, 2022 ).…”