Predictors of 5-year mortality in pulmonary &lt;I&gt;Mycobacterium avium-intracellulare&lt;/I&gt; complex disease

Ito, Yutaka; Hirai, Toyohiro; Maekawa, Koichi; Fujita, Kohei; Imai, Seiichiro; Tatsumi, Shuji; Handa, Tomohiro; Matsumoto, Hitomi; Muro, Shinichiro; Niimi, Akio; Mishima, Michiaki

doi:10.5588/ijtld.11.0148

Cited by 87 publications

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“…The 1-year mortality rate in our study (9%) was lower than that (25%) found in a previous study of macrolide-resistant MAC-LD (14), although the 5-year mortality rate was significantly higher (47%) in the present study. Moreover, the 5-year mortality rate in patients with macrolide-resistant MAC-LD in our study was much higher than those (13 to 26%) in patients with newly diagnosed MAC-LD in previous studies (35)(36)(37). These time-dependent increases in mortality indicate the difficulty of managing patients with macrolide-resistant MAC-LD.…”

Section: Discussioncontrasting

confidence: 51%

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Moon

Park

Kim

et al. 2016

Antimicrob Agents Chemother

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Section: Discussioncontrasting

confidence: 51%

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Moon

Park

Kim

et al. 2016

Antimicrob Agents Chemother

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“…8,9 Mycobacteria have high genetic diversity, even within species, 31 and varying virulence could be part of this diversity. Tatano and colleagues 32 compared in vitro virulence of five strains of M avium isolates from patients with NB with fi ve strains isolated from patients with cavitary PNTM, a form of disease associated with higher mortality, 33 to determine whether diff erences in virulence correlated with diff erent patterns of disease. No signifi cant diff erences were found among any of the strains tested with respect to cellular internalization, replication within human type 2 alveolar cells and macrophages, or macrophage production of reactive nitrogen or oxygen species or susceptibility to either of these macrophage antimicrobial mechanisms.…”

Section: Iatrogenic Risk Factorsmentioning

confidence: 99%

Pulmonary Disease Due to Nontuberculous Mycobacteria

McShane

Glassroth

2015

Chest

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“…Patients with fibrocavitary disease usually require immediate treatment because cavitary disease is associated with a higher rate of mortality due to NTM pulmonary disease [14,15].…”

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confidence: 99%

“…Initiation of NTM treatment should be individualized considering disease types, comorbid conditions, and age. Patients with fibrocavitary disease usually require immediate treatment because the presence of cavitary disease is associated with higher mortality rate [19,20]. A study demonstrated that clarithromycin and capreomycin have high antimicrobial activities against M. intracellulare isolates; clarithromycin and amikacin resistance could be more readily and rapidly detected using molecular scanning of corresponding drug target than conventional drug susceptibility testing.…”

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confidence: 99%

Mycobacterium Tuberculosis and Nontuberculous Mycobacteria Coinfection of the Lungs

2017

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Tuberculosis is highly prevalent in our country and nontuberculous mycobacteria (NTM) are frequently found in respiratory specimens recently. A 65-year-old woman was admitted with complaints of fever, cough, weight loss, and hemoptysis. On the patient's chest radiography an upper lobe cavity in both lungs and consolidation was detected. Acid-fast bacilli 4+ were observed in smear of sputum and culture results M. intracellulare and M. tuberculosis were observed together. The patient's treatment was arranged. Through this case, we want to emphasize that tuberculosis and nontuberculous mycobacterial disease can coexist. KEYWORDS: M. tuberculosis, M. intracellulare, coinfection INTRODUCTIONNontuberculous mycobacteria (NTM) pulmonary diseases are being increasingly detected. Cavitary NTM pulmonary disease is radiographically and clinically indistinguishable from pulmonary tuberculosis. Risk group of NTM infection include elderly persons; alcoholics; smokers with COPD. CASE PRESENTATIONA 65-year-old woman was admitted with complaints of fever, cough, weight loss, and hemoptysis. We observed an upper lobe cavity in both lungs and consolidation on the patient's chest radiography and chest computed tomography scans (Figures 1 and 2). Tuberculin skin test result was 19 mm and acid-fast bacilli 4+ were observed in acid-fast bacilli smear of sputum. The patient was extremely cachectic and weighed only 28 kg. Drugs were set while considering the weight, and therapy with four drugs (INH, RIF, EMB, and PRZ) was started. COPD was a comorbid factor for tuberculosis, and HIV test was negative. Informed constent form was obtained from the patient. Mycobacterium tuberculosis was obtained from sputum cultures. In the follow-up culture results, M. intracellulare and M. tuberculosis were observed together. In order to verify the patient culture results, two sputum cultures taken on separate days were sent to another center, where the same results were obtained. INH and RIF susceptibility were detected in the culture tests. After M. intracellulare was observed in the two sputum cultures, clarithromycin treatment was also added to the first drugs. The patient regularly received the medication, and no side effects were observed. The patient came to to the outpatient clinic once a month in the follow-up period. In the third month of treatment, acid-fast bacilli smear of the sputum was negative. During subsequent follow-up, she did not give sputum sample. EMB and PRZ were discontinued in the third month; the remaining drugs were continued. During the sixth month of treatment, regression of the chest X-ray cavities and consolidation was observed, and the patient's weight increased to 35 kg (Figure 3). The patient did not come to the hospital and she died in the eight month of treatment. Through this case, we want to emphasize that tuberculosis and nontuberculous mycobacterial disease can coexist. Therefore, culture results should be carefully monitored.

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Predictors of 5-year mortality in pulmonary <I>Mycobacterium avium-intracellulare</I> complex disease

Abstract: Patients with cavitary lesions require immediate treatment for sputum culture conversion and to improve their chances of survival.

Cited by 87 publications

References 0 publications

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Pulmonary Disease Due to Nontuberculous Mycobacteria

Mycobacterium Tuberculosis and Nontuberculous Mycobacteria Coinfection of the Lungs

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