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Shteinberg M, Boyd J, Aliberti S, Polverino E, Harris B, Berg T, Posthumus A, Ruddy T, Goeminne P, Lloyd E, Alan T, Altenburg J, Crossley B, Blasi F, Chalmers J. What is important for people with nontuberculous mycobacterial disease? An EMBARC-ELF patient survey. ERJ Open Res 2021; 7:00807-2020. [PMID: 33614773 PMCID: PMC7882780 DOI: 10.1183/23120541.00807-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/05/2022] Open
Abstract
The prevalence of nontuberculous mycobacteria (NTM) pulmonary disease (NTM-PD) is rising worldwide, creating a significant health issue and an unmet need. The diagnosis and decision to treat NTM-PD are often a challenge, with complex criteria for diagnosis and multiple factors weighing in the decision to treat [1]. The treatment is lengthy and the drugs used often associated with adverse effects. Adherence to NTM-PD management guidelines were found to be suboptimal, impacting treatment success [2], with substantial differences in physicians’ decision to treat and in their adherence to treatment guidelines [2–4]. Patients’ experiences of NTM pulmonary disease highlight important and unmet needs for better pharmacological treatment and education of medical staffhttps://bit.ly/3mjrlwh
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Affiliation(s)
- Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center and the Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Stefano Aliberti
- Dept of Pathophysiology and Transplantation, University of Milan, and Internal Medicine Dept, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Eva Polverino
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Thorax Institute, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Bridget Harris
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Tove Berg
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Annette Posthumus
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Thomas Ruddy
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Pieter Goeminne
- Dept of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Ernie Lloyd
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Timothy Alan
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Josje Altenburg
- Dept of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara Crossley
- European Lung Foundation Bronchiectasis Patient Advisory Group, Edinburgh, UK
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, and Internal Medicine Dept, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - James Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Lopez-Luis BA, Sifuentes-Osornio J, Pérez-Gutiérrez MT, Chávez-Mazari B, Bobadilla-Del-Valle M, Ponce-de-León A. Nontuberculous mycobacterial infection in a tertiary care center in Mexico, 2001-2017. Braz J Infect Dis 2020; 24:213-220. [PMID: 32428442 PMCID: PMC9392119 DOI: 10.1016/j.bjid.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. METHODS We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). RESULTS A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p=0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p=0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p=0.27). CONCLUSIONS Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
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Affiliation(s)
- Bruno Ali Lopez-Luis
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - María Teresa Pérez-Gutiérrez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Bárbara Chávez-Mazari
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Miriam Bobadilla-Del-Valle
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico.
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Ghio AJ, Smith GS, DeFlorio-Barker S, Messier KP, Hudgens E, Murphy MS, Maillard JM, Stout JE, Hilborn ED. Application of diagnostic criteria for non-tuberculous mycobacterial disease to a case series of mycobacterial-positive isolates. J Clin Tuberc Other Mycobact Dis 2019; 17:100133. [PMID: 31867444 PMCID: PMC6904831 DOI: 10.1016/j.jctube.2019.100133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) have provided guidelines to assist in the accurate diagnosis of lung disease caused by nontuberculous mycobacteria (NTM). These microbiologic, radiographic, and clinical criteria are considered equally important and all must be met to make the diagnosis of NTM lung disease. To assess the significance of the three criteria, each was evaluated for its contribution to the diagnosis of NTM lung disease in a case series. Laboratory reports of any specimen positive for NTM isolation were collected between January 1, 2006 and December 31, 2010 at a university medical center. Medical records were reviewed in detail using a standardized form. The total number of patients with a culture from any site positive for NTM was 297 while the number from respiratory specimens during the same period was 232 (78%). Samples from two of these patients also yielded M. tuberculosis complex and were excluded. While 128 of the remaining 230 patients (55.7%) in the cohort met the microbiologic criterion for diagnosis of NTM lung disease, 151 (65.6%) and 189 (78.3%) met the radiologic and clinical criteria respectively. Only 78 patients (33.9%) met all three criteria provided by the ATS/IDSA for diagnosis of NTM lung disease. This evaluation reaffirms that defining NTM lung disease using either one or two of the criteria provided by the 2007 ATS/IDSA guidelines may significantly overestimate the number of cases of NTM lung disease. Based on the experience of defining NTM lung disease in this case series, recommendations for modification of the ATS/IDSA guidelines are provided which include expansion of both radiologic patterns and the list of symptoms associated with NTM lung disease.
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Affiliation(s)
- Andrew J Ghio
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
| | - Genee S Smith
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Stephanie DeFlorio-Barker
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
| | | | - Edward Hudgens
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
| | | | | | | | - Elizabeth D Hilborn
- Human Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA
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Provoost J, Valour F, Gamondes D, Roux S, Freymond N, Perrot E, Souquet PJ, Kiakouama-Maleka L, Chidiac C, Lina G, Dumitrescu O, Sénéchal A, Ader F. A retrospective study of factors associated with treatment decision for nontuberculous mycobacterial lung disease in adults without altered systemic immunity. BMC Infect Dis 2018; 18:659. [PMID: 30547753 PMCID: PMC6295085 DOI: 10.1186/s12879-018-3559-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) lung diseases are increasingly recognized as chronic opportunistic infections, occurring in individuals with a wide variety of underlying conditions. In the absence of systemic immunodeficiency, decision of NTM lung disease treatment must relies on a careful risk/benefit assessment, given the requirement of long-term administration of multidrug therapies supported by limited evidence. The primary objective was to identify the factors associated with anti-NTM treatment initiation. Clinical and radiological outcome upon treatment were studied. Methods This retrospective, single center study (2013–2016, 45 months) addressed the criteria supporting treatment decision among adults with NTM lung disease without systemic immunodeficiency at our institution, with the assigned goal to harmonize the practice. All patients matched the current international definitions of NTM lung disease according to the American Thoracic Society criteria. Factors associated with anti-NTM treatment were investigated by conditional logistic regression. Clinical and radiological outcomes of treated and untreated NTM-disease cases were examined. Mortality rate was assessed. An expert radiologist conducted a blinded computed tomography (CT)-scan review of the treated and untreated patients. Results Among 51 cases of NTM lung diseases, 25 (49%) received anti-NTM treatment. In univariate analysis, a body mass index (BMI) < 18 kg/m2 (odds ratio (OR), 4.2 [95% confidence interval (CI) 1.2–15.2]; p = 0.042), hemoptysis (OR, 11.8 [95% CI 1.35–12.9]; p = 0.026), excavation(s) (OR, 4.8 [95% CI 1.4–16.4], p = 0.012), prior anti-NTM treatment (OR, 5.65 [95% CI 1.06–29.9]; p = 0.042), Aspergillus spp. co-infection (OR, 6.3 [95% CI 1.8–22.2]; p = 0.004) were associated with treatment initiation. In multivariate analysis, Aspergillus spp. co-infection was the only independent determinant of treatment initiation (OR, 5.3 [95% CI 1.1–25.4]; p = 0.036). Twenty-one (81%) patients received ≥3 anti-NTM drugs. Median treatment duration and follow-up were 36.3 (interquartile range [IQR], 13.1–64.4) weeks and 17.1 (IQR, 8.7–27.1) months, respectively. Regarding radiological outcome, 85 CT-scans were reviewed, showing similar rates of regression or stabilization in treated and untreated patients. Overall mortality rate was not different in treated and untreated patients. Conclusion The most relevant variable associated with anti-NTM treatment initiation was Aspergillus spp. co-infection. Radiological regression or stabilization of pulmonary lesions was not different between the treated and untreated patients.
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Affiliation(s)
- Judith Provoost
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Florent Valour
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France.,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | | | - Sandrine Roux
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France
| | | | - Emilie Perrot
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Jean Souquet
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | | | - Christian Chidiac
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Gérard Lina
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Oana Dumitrescu
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Agathe Sénéchal
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France. .,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France. .,Université Claude Bernard Lyon 1, Lyon, France.
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