Surgical resection is sufficient for incidentally discovered solitary pulmonary nodule caused by nontuberculous mycobacteria in asymptomatic patients

Abstract

Incidentally discovered solitary pulmonary nodules (SPN) caused by nontuberculous mycobacteria (NTM) is uncommon, and its optimal treatment strategy remains uncertain. This cohort study determined the clinical characteristics and outcome of asymptomatic patients with NTM-SPN after surgical resection. Resected SPNs with culture-positive for NTM in six hospitals in Taiwan during January, 2010 to January, 2017 were identified. Asymptomatic patients without a history of NTM-pulmonary disease (PD) or same NTM species isolated from the respiratory samples were selected. All were followed until May 1, 2019. A total of 43 patients with NTM-SPN were enrolled. Mycobacterium avium complex (60%) and M. kansasii (19%) were the most common species. The mean age was 61.7 ± 13.4. Of them, 60% were female and 4% had history of pulmonary tuberculosis. The NTM-SPN was removed by wedge resection in 38 (88%), lobectomy in 3 (7%) and segmentectomy in 2 (5%). Caseating granuloma was the most common histologic feature (58%), while chronic inflammation accounts for 23%. Mean duration of the follow-up was 5.2 ± 2.8 years (median: 4.2 years [2.5–7.0]), there were no mycobacteriology recurrence or NTM-PD development. In conclusion, surgical resection is likely to curative for incidentally discovered NTM-SPN in asymptomatic patients without culture evidence of the same NTM species from respiratory specimens, and routine mycobacterium culture for resected SPN might be necessary for differentiating pulmonary tuberculosis and NTM because further treatment differs.

Analysis of pulmonary nodules caused by nontuberculous mycobacteriosis in 101 resected cases: multi-center retrospective study

“…MAC was the most common species in the present SN-NTM cases, the same as noted in previous reports (3,(5)(6)(7)(8)(9), while nodules due to M. kansasii were noted in 8. Huang also reported SN-NTM caused by M. kansasii in 19% of their cases, followed by MAC (10).…”

Challenging Case of Mycobacterium Avium Complex (MAC) Disease in a Malnourished Non-HIV Patient

“…Surgical interventions such as wedge resection may offer long-term resolution, particularly in refractory NTM infections. A recent study showed that wedge resection could prevent the recurrence of refractory NTM (including MAC) for around 8 years [3].…”

“…Aerosol transmission is hypothesized, and MAC's slow growth on solid media poses challenges in diagnosis and treatment. MAC's resistance to traditional antimicrobials emphasizes the need for tailored therapeutic approaches [3]. The disease spectrum ranges from respiratory manifestations to disseminated infections, affecting immunocompromised hosts disproportionately.…”