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Kwak N, Moon J, Kim JY, Park JW, Yim JJ. Clinical course of nontuberculous mycobacterial pulmonary disease in patients with rheumatoid arthritis. Adv Rheumatol 2024; 64:20. [PMID: 38491558 DOI: 10.1186/s42358-024-00357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVES The impact of rheumatoid arthritis (RA) on nontuberculous mycobacterial pulmonary disease (NTM-PD) has not been well established. In this study, we investigated the clinical course of NTM-PD in patients with RA and the impact of RA on the prognosis of NTM-PD. METHODS We analyzed patients who developed NTM-PD after being diagnosed with RA from January 2004 to August 2023 at a tertiary referral hospital in South Korea. The patient's baseline characteristics, clinical course, and prognosis were evaluated. An optimal matching analysis was performed to measure the impact of RA on the risk of mortality. RESULTS During the study period, 18 patients with RA [median age, 68 years; interquartile range (IQR) 59-73; female, 88.9%] developed NTM-PD. The median interval between RA diagnosis and subsequent NTM-PD development was 14.8 years (IQR, 8.6-19.5). At a median of 30 months (IQR, 27-105) after NTM-PD diagnosis, 10 of 18 (55.6%) patients received anti-mycobacterial treatment for NTM-PD and 5 (50.0%) patients achieved microbiological cure. When matched to patients with NTM-PD but without RA, patients with both RA and NTM-PD had a higher risk of mortality (adjusted hazard ratio, 8.14; 95% confidence interval, 2.43-27.2). CONCLUSION NTM-PD occurring after RA is associated with a higher risk of mortality than NTM-PD in the absence of RA.
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Affiliation(s)
- Nakwon Kwak
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongo-Gu, Seoul, 03080, South Korea
| | - Jinyoung Moon
- Chaum Life Center, CHA University School of Medicine, Seoul, South Korea
| | - Joong-Yub Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongo-Gu, Seoul, 03080, South Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Joon Yim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongo-Gu, Seoul, 03080, South Korea.
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2
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Goulabchand R, Makinson A, Morel J, Witkowski-Durand-Viel P, Nagot N, Loubet P, Roubille C, Noel D, Morquin D, Henry K, Mura T, Guilpain P. Hospitalizations for infections in primary Sjögren's syndrome patients: a nationwide incidence study. Ann Med 2022; 54:2672-2680. [PMID: 36173925 PMCID: PMC9542339 DOI: 10.1080/07853890.2022.2126517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary Sjögren's syndrome (pSS) is an autoimmune disease with increased risk of infections. Here, we assessed whether pSS patients were at higher risk of hospitalization for community and opportunistic infections. METHODS We selected newly hospitalized pSS patients between 2011 and 2018, through a nationwide population-based retrospective study using the French Health insurance database. We compared the incidence of hospitalization for several types of infections (according to International Classification for Disease codes, ICD-10) between pSS patients and an age- and sex-matched (1:10) hospitalized control group. We calculated adjusted Hazard Ratios (aHR, 95% CI) adjusted on socio-economic status, past cardiovascular or lung diseases and blood malignancies factors. RESULTS We compared 25 661 pSS patients with 252 543 matched patients. The incidence of hospitalizations for a first community infection was increased in pSS patients [aHR of 1.29 (1.22-1.31), p < .001]. The incidence of hospitalization for bronchopulmonary infections was increased in pSS patients [aHR of 1.50 (1.34-1.69), p < .001, for pneumonia]. Hospitalizations for pyelonephritis and intestinal infections were increased [aHR of 1.55 (1.29-1.87), p < .001 and 1.18 (1.08-1.29), p < .001, respectively]. Among opportunistic infections, only zoster, and mycobacteria infections (tuberculosis and non-tuberculous) were at increased risk of hospitalization [aHR of 3.32 (1.78-6.18), p < .001; 4.35 (1.41-13.5), p = .011 and 2.54 (1.27-5.06), p = .008, respectively]. CONCLUSIONS pSS patients are at higher risk of hospitalization for infections. The increased risk of hospitalization for mycobacterial infections illustrates the potential bilateral relationship between the two conditions. Vaccination against respiratory pathogens and herpes zoster virus may help prevent some hospitalizations in pSS patients.KEY MESSAGESPrimary Sjögren's syndrome (pSS) increases hospitalization risk for community infections: bronchopulmonary, skin, dental, ear-nose-throat, intestinal infections and pyelonephritis.Hospitalizations for zoster and mycobacterial infections are also increased in this population.Dedicated preventive measures and vaccination campaigns could decrease the burden of infections in pSS patients.
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Affiliation(s)
- Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University Montpellier, Nîmes, France.,University of Montpellier, Montpellier, France.,IRMB, University of Montpellier, INSERM, Montpellier, France
| | - Alain Makinson
- University of Montpellier, Montpellier, France.,Department of Infectiology, INSERM U1175, Saint Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - Jacques Morel
- University of Montpellier, Montpellier, France.,Department of Rheumatology, Montpellier University Hospital, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Philine Witkowski-Durand-Viel
- University of Montpellier, Montpellier, France.,Department of Internal Medicine and Multi-organic Diseases, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Nicolas Nagot
- University of Montpellier, Montpellier, France.,Department of Medical Information, Montpellier University Hospital, Montpellier, France
| | - Paul Loubet
- University of Montpellier, Montpellier, France.,Department of infectious and Tropical Diseases, CHU Nîmes, University Montpellier, Nîmes, France
| | - Camille Roubille
- University of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Department of Internal medicine, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Danièle Noel
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | - David Morquin
- University of Montpellier, Montpellier, France.,Department of Infectiology, INSERM U1175, Saint Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - Kim Henry
- Department of Internal Medicine and Multi-organic Diseases, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Thibault Mura
- University of Montpellier, Montpellier, France.,Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Philippe Guilpain
- University of Montpellier, Montpellier, France.,IRMB, University of Montpellier, INSERM, Montpellier, France.,Department of Internal Medicine and Multi-organic Diseases, St Eloi Hospital, Montpellier University Hospital, Montpellier, France
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3
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Henry K, Deligny C, Witkowski Durand Viel P, Morel J, Guilpain P, Goulabchand R. [Infections in primary Sjögren's syndrome patients: "Real-life" study of 109 patients from Montpellier university hospital]. Rev Med Interne 2022; 43:696-702. [PMID: 36372632 DOI: 10.1016/j.revmed.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Infections are responsible for a part of the overall mortality in primary Sjögren's syndrome patients (pSS). Our retrospective monocentric study aimed at describing infections reported in a population of pSS hospitalized patients, along with the characteristics of their disease. METHODS Patients with SS have been randomly selected from our hospital database claim, between 2009 and 2018. After careful analysis of their medical chart, only patients with pSS and fulfilling ACR/EULAR 2016 diagnosis criteria were included. We collected main clinical, biological and pathological characteristics of SS, along with all the reported infections during the follow-up. The characteristics of the disease were compared according to the presence of an infection in hospitalization. RESULTS In total, 109 pSS patients were included (93% of women, mean age 53.6±14.3 years, mean follow-up 8.2±8.4 years). Fifty-one percent had been exposed to hydroxychloroquine (HCQ). Seventy-eight infections were recorded in 47 (43%) patients. Twenty-five infections were recorded in hospitalization (5 in critical care) in 20 (18%) patients, whom leading causes were urinary tract (28%), pulmonary (24%), ENT (16%), and intestinal (12%) infections. pSS patients with infections in hospitalization were older, exhibited more hypocomplementemia, and were less exposed to HCQ. We found no difference in immunosuppressive treatments exposure. CONCLUSIONS The impact of HCQ exposure on infectious risk needs further investigations. Broad vaccination campaign and tight control of sicca syndrome could lead to a better control of infection risk.
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Affiliation(s)
- K Henry
- Département de médecine interne et maladies multi-organiques (MIMMO), CHU de Montpellier, hôpital Saint-Éloi, Montpellier, France; Service de médecine interne, CHU de Pierre-Zobda-Quitman, Fort-de-France, Martinique, France.
| | - C Deligny
- Service de médecine interne, CHU de Pierre-Zobda-Quitman, Fort-de-France, Martinique, France
| | - P Witkowski Durand Viel
- Département de médecine interne et maladies multi-organiques (MIMMO), CHU de Montpellier, hôpital Saint-Éloi, Montpellier, France; Université Montpellier, Montpellier, France
| | - J Morel
- Université Montpellier, Montpellier, France; Département de rhumatologie, CHU de Montpellier, hôpital Lapeyronie, Montpellier, France; Inserm, PhyMedExp, CNRS, université de Montpellier, Montpellier, France
| | - P Guilpain
- Département de médecine interne et maladies multi-organiques (MIMMO), CHU de Montpellier, hôpital Saint-Éloi, Montpellier, France; Université Montpellier, Montpellier, France; Inserm, IRMB, université Montpellier, Montpellier, France
| | - R Goulabchand
- Université Montpellier, Montpellier, France; Inserm, IRMB, université Montpellier, Montpellier, France; Médecine interne, CHU de Nîmes, Nîmes, France.
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4
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Chai J, Han X, Mei Q, Liu T, Walline JH, Xu J, Liu Y, Zhu H. Clinical Characteristics and Mortality of Non-tuberculous Mycobacterial Infection in Immunocompromised vs. Immunocompetent Hosts. Front Med (Lausanne) 2022; 9:884446. [PMID: 35665363 PMCID: PMC9159854 DOI: 10.3389/fmed.2022.884446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Immunosuppression and host vulnerability play a key role in non-tuberculous mycobacteria (NTM) pathogenesis. The objective of this study was to compare the clinical characteristics and mortality of NTM infections in immunocompromised and immunocompetent patients. We used a retrospective dataset obtained from our large, tertiary, urban, teaching hospital which is the medical records of hospitalized patients with NTM infections between January 1, 2013 to December 31, 2020. The information including clinical manifestations, imaging, and NTM etiological data were obtained from the hospital's clinical data system. A total of 480 patients with NTM infections completed species identification. 118 hospitalized NTM patients who met ATS/IDSA NTM diagnostic criteria and had complete medical records were included in the study. The average age was 49.4 years, 57 (48.3%) were female, and 64 (54.2%) were immunosuppressed hosts. In our study, the most common species in order of frequency were: M. intracellulare, M. abscessus, M. avium, and M. kansasii among NTM patients. The most common comorbidity was history of previous tuberculosis (30.5%). Besides malignancy, the most common immunodeficiencies were adult-onset immunodeficiency induced by anti-interferon-gamma autoantibody, SLE, and vasculitis. The immunocompromised patients with NTM had more clinical symptoms, comorbidities and lower lymphocyte counts compared to immunocompetent patients. The mortality we observed in immunocompromised patients of NTM disease was significantly higher than that of immunocompetent patients (HR 3.537, 95% CI 1.526–8.362). Immunosuppressed NTM patients with lower B and CD4+ T lymphocyte counts may more frequently present with disseminated NTM infections, clinical exacerbations, and higher mortality than immunocompetent patients.
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Affiliation(s)
- Jingjing Chai
- Emergency Department, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Han
- Emergency Department, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qimin Mei
- Emergency Department, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Liu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Jia Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yecheng Liu
- Emergency Department, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadong Zhu
- Emergency Department, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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5
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Kumar K, Loebinger MR. Nontuberculous Mycobacterial Pulmonary Disease: Clinical Epidemiologic Features, Risk Factors, and Diagnosis: The Nontuberculous Mycobacterial Series. Chest 2022; 161:637-646. [PMID: 34627854 DOI: 10.1016/j.chest.2021.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/26/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022] Open
Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) continues to impose a significant clinical burden of disease on susceptible patients. The incidence of NTM-PD is rising globally, but it remains a condition that is challenging to diagnose and treat effectively. This review provides an update on the global epidemiologic features, risk factors, and diagnostic considerations associated with the management of NTM-PD.
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Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Michael R Loebinger
- National Heart and Lung Institute, Imperial College London, London, England; Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England.
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6
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Chen HH, Lin CH, Chao WC. Mortality association of nontuberculous mycobacterial infection requiring treatment in Taiwan: a population-based study. Ther Adv Respir Dis 2022; 16:17534666221103213. [PMID: 35748569 PMCID: PMC9234830 DOI: 10.1177/17534666221103213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Infection due to nontuberculous mycobacteria (NTM) is an emerging issue
worldwide, and we aimed to address the epidemiology and mortality
association of NTM infection requiring treatment in Taiwan. Methods: We used the 2003–2018 data of 2 million representative individuals in
Taiwan’s National Health Insurance Research Database. We identified patients
with newly diagnosed NTM infection and received treatment as NTM cases. Age-
and sex-matched (1:40) as well as propensity score-matched (PSM) (1:2)
non-NTM individuals were selected as non-NTM controls. We used a Cox
proportional hazard model to determine hazard ratios (HRs) with 95%
confidence intervals (CIs). Results: We identified 558 patients with NTM infection requiring treatment. The mean
age was 62.5 ± 15.4 years, and 57.5% of them were male. The incidence
increased from 0.54 per 100,000 person-year in 2003 to 3.35 per 100,000
person-year in 2018. The overall mortality was 35.2%, with a mean follow-up
duration of 4.1 ± 3.6 years. We found that NTM infection was independently
associated with a greater risk of mortality (HR: 1.71; 95% CI: 1.47–1.98)
compared with age- and sex-matched controls, and the association remained
consistent (HR: 1.44; 95% CI: 1.19–1.75) compared with propensity-matched
controls. We also found that old age, male, high Charlson comorbidity index,
and the use of steroids or anti-neoplastic agents/immunosuppressants were
associated with mortality risk. Conclusion: In conclusion, we found a steady increase in patients with NTM infection
requiring treatment in Taiwan and further demonstrated that NTM infection
was associated with greater risk of mortality using two comparable non-NTM
control subjects.
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Affiliation(s)
- Hsin-Hua Chen
- Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City.,Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung City.,College of Medicine, National Chung Hsing University, Taichung City.,Big Data Center, National Chung Hsing University, Taichung City.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung City
| | - Ching-Heng Lin
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung City.,Department of Medical Research, Taichung Veterans General Hospital, Taichung City.,Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei City.,Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City
| | - Wen-Cheng Chao
- College of Medicine, National Chung Hsing University, Taichung City.,Big Data Center, Chung Hsing University, Taichung City.,Department of Critical Care Medicine, Taichung Veterans General Hospital, No. 1650, Boulevard, Section 4, Xitun District, Taichung City 40705.,Department of Automatic Control Engineering, Feng Chia University, Taichung City
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7
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Pego-Reigosa JM, Restrepo Vélez J, Baldini C, Rúa-Figueroa Fernández de Larrinoa Í. Comorbidities (excluding lymphoma) in Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:2075-2084. [PMID: 30770715 DOI: 10.1093/rheumatology/key329] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
The information about comorbidities (excluding lymphoma) in primary Sjögren's syndrome (pSS) is relatively scarce. Cardiovascular disease, infections, musculoskeletal conditions or malignancy are likely the most relevant comorbid conditions in pSS. Different infections (particularly oral candidal infections) and fibromyalgia are extremely frequent in the daily clinical practice. On the other hand, the incidence of cardiovascular events and cancer in pSS is low, so information about them comes from large epidemiological studies or meta-analysis. For this reason, preclinical vascular disease is investigated by different techniques, demonstrating the presence of early atherosclerosis in pSS patients. Coronary events could be slightly more frequent in pSS than in the general population. The overall risk of malignancy in pSS patients seems to be slightly increased, likely due to excess occurrence of lymphoma. An association between pSS and thyroid cancer might exist, although it should be confirmed by further investigations.
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8
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Weingart MF, Li Q, Choi S, Maleki-Fischbach M, Kwon YS, Koelsch T, Dow CT, Truong TQ, Chan ED. Analysis of Non-TB Mycobacterial Lung Disease in Patients With Primary Sjögren's Syndrome at a Referral Center. Chest 2021; 159:2218-2221. [PMID: 33440182 DOI: 10.1016/j.chest.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Melanie F Weingart
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Qing Li
- School of Public Health, San Diego State University, San Diego, CA; Department of Academic Affairs, National Jewish Health, Denver, CO
| | - Sangbong Choi
- Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Mehrnaz Maleki-Fischbach
- Department of Allergy and Immunology and Division of Rheumatology, National Jewish Health, Denver, CO
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Tilman Koelsch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Coad Thomas Dow
- McPherson Eye Research Institute, University of Wisconsin, Madison, WI
| | - Tho Q Truong
- Department of Allergy and Immunology and Division of Rheumatology, National Jewish Health, Denver, CO
| | - Edward D Chan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO; Department of Academic Affairs, National Jewish Health, Denver, CO.
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9
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Uno S, Asakura T, Morimoto K, Yoshimura K, Uwamino Y, Nishimura T, Hoshino Y, Hasegawa N. Comorbidities associated with nontuberculous mycobacterial disease in Japanese adults: a claims-data analysis. BMC Pulm Med 2020; 20:262. [PMID: 33036598 PMCID: PMC7547454 DOI: 10.1186/s12890-020-01304-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacterial (NTM) lung disease is one of a growing number of chronic health problems that is difficult to cure in aging societies. While it is important to be vigilant about associated comorbidities in order to provide better patient care, data on the prevalence of comorbidities stratified by country or region are scarce. We aimed to elucidate the comorbidities associated with NTM disease based on Japanese health insurance claims data. METHODS Cross-sectional analyses were performed using the claims data for 2014 provided by the Japan Medical Data Center Co., Ltd. Patients aged 20-75 years with ≥3 claims associated with NTM disease were identified and matched to 10 sex-and-age-matched controls that had never made a claim for NTM disease. Thirty-one comorbidities previously suspected to be associated with NTM disease were selected, and the prevalence of these comorbidities compared between cases and controls. RESULT Overall, 419 NTM patients (134 males and 285 females) and 4190 non-NTM controls were identified from the JMDC database. Aspergillosis, asthma, chronic heart failure, diffuse panbronchiolitis, gastroesophageal reflux, interstitial pneumonia, lung cancer, cancer other than breast, lung, ovary, or prostate cancer, and rheumatoid arthritis were associated with NTM disease in both males and females. Chronic obstructive pulmonary disease was associated with NTM in males while chronic kidney disease, osteoporosis, and Sjögren syndrome were associated with NTM in females. CONCLUSION NTM disease was associated with multiple comorbidities that should be considered when providing medical care to individuals with NTM disease.
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Affiliation(s)
- Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kozo Morimoto
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.,Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kimio Yoshimura
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Uwamino
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan.,Department of Laboratory medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Yoshihiko Hoshino
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan.
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10
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Shumway C, Aggarwal S, Park ST, Wade M, Kedhar S. Complicated case of Mycobacterium abscessus conjunctivitis in Sjögren's syndrome. Am J Ophthalmol Case Rep 2020; 19:100765. [PMID: 32548334 PMCID: PMC7286968 DOI: 10.1016/j.ajoc.2020.100765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 10/26/2022] Open
Abstract
Purpose To report a case of conjunctivitis due to Mycobacterium abscessus in the setting of keratoconjunctivitis sicca due to Sjögren's syndrome in the absence of other known risk factors such as surgery, trauma or immunosuppressive therapy. Observations A 61-year-old woman with a history of keratoconjunctivitis sicca secondary to Sjögren's syndrome presented with dryness, irritation, redness, and discharge in her left eye for 2 months. She was diagnosed with chronic conjunctivitis and began a regimen of moxifloxacin and an ocular ointment of dexamethasone, neomycin, and polymyxin with no improvement of symptoms. Concurrent cultures grew Mycobacterium abscessus and the patient began treatment with amikacin drops, oral clarithromycin and intravenous imipenem, followed by amikacin drops, oral clarithromycin, and oral clofazimine, but her course was complicated by a perforated corneal ulcer that required a corneal patch graft. The patient eventually recovered despite persistent colonization. Conclusions/importance We present a case of Mycobacterium abscessus conjunctivitis in a patient with keratoconjunctivitis sicca secondary to Sjögren's syndrome without previous history of surgery, trauma, or other known risk factors. Because of low suspicion and clinician awareness, ocular nontuberculous mycobacteria (NTM) infection may have a delayed diagnosis and treatment. Clinicians should consider NTM in the differential diagnosis in patients with autoimmune disease such as Sjögren's syndrome. Treatment may be lengthy, requiring topical and systemic antibiotics and is often complicated due to resistance.
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Affiliation(s)
- Caleb Shumway
- John A. Moran Eye Center, University of Utah, Salt Lake City, 84132, United States
| | - Sahil Aggarwal
- Gavin Herbert Eye Institute, University of California, Irvine, 92697, United States
| | - Steven T Park
- Division of Infectious Diseases, University of California, Irvine Medical Center, United States
| | - Matthew Wade
- Gavin Herbert Eye Institute, University of California, Irvine, 92697, United States
| | - Sanjay Kedhar
- Gavin Herbert Eye Institute, University of California, Irvine, 92697, United States
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Shu CC, Wu MF, Pan SW, Wu TS, Lai HC, Lin MC. Host immune response against environmental nontuberculous mycobacteria and the risk populations of nontuberculous mycobacterial lung disease. J Formos Med Assoc 2020; 119 Suppl 1:S13-S22. [PMID: 32451216 DOI: 10.1016/j.jfma.2020.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/16/2022] Open
Abstract
Nontuberculous mycobacterial lung disease (NTM-LD) prevalence has been increasing over the recent decades. Numerous host factors are associated with NTM-LD development, including susceptible phenotypes such as ciliary defect and lung structural change, pulmonary clearance defect with poor clearance of secretions, and immune suppression. Specifically, regarding the susceptible host phenotypes without clear pathogenesis, a slender body, pectus excavatum, and postmenopausal female status are common. Also, decreased host immunity to NTM, especially T helper 1 cell responses is frequently observed. Even so, the underlying mechanisms remain unclear and relevant large-scale studies are lacking. Infections due to host genetics associated defects are mostly untreatable but rare in Asia, particularly Taiwan. Nevertheless, some risks for NTM-LD are controllable over disease progression. We suggest that clinicians first manage host factors and deal with the controllable characteristics of NTM-LD, followed by optimizing anti-NTM treatment. Further researches focusing on NTM-LD pathogenesis, especially the host-NTM interaction may advance understanding the nature of the disease and develop efficient therapeutic regimens.
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Affiliation(s)
- Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Fang Wu
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Statistical Sciences, Academia Sinica, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fuxing St., Guishan Dist., Taoyuan 33305, Taiwan.
| | - Hsin-Chih Lai
- Central Research Laboratory, Xiamen Chang Gung Hospital, Xiamen, Fujian, China; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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Li JA, Cheng YY, Cui ZT, Jiang W, Zhang WQ, Du ZH, Gao B, Xie YY, Meng HM. Disseminated histoplasmosis in primary Sjögren syndrome: A case report. World J Clin Cases 2020; 8:1319-1325. [PMID: 32337209 PMCID: PMC7176620 DOI: 10.12998/wjcc.v8.i7.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sjögren syndrome (SS) is a chronic and systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands. And histoplasmosis is an invasive mycosis caused by the saprophytic dimorphic fungus H. capsulatum. In patients with primary SS (PSS), disseminated histoplasmosis (DH) is extremely rare.
CASE SUMMARY We report a 37-year-old female patient admitted to our hospital with exacerbating fatigue, somnolence, and pancytopenia as the main symptoms. She was eventually diagnosed with DH based on pancytopenia, splenomegaly, and findings of bone marrow smears. The atypical clinical symptoms made the diagnosis process more tortuous. Unfortunately, she died of respiratory failure on the day the diagnosis was confirmed.
CONCLUSION We present a rare and interesting case of DH in a PSS patient. This case updates the geographic distribution of histoplasmosis in China, and expands the clinical manifestations of DH in PSS, highlighting the significance of constantly improving the understanding of PSS with DH.
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Affiliation(s)
- Jia-Ai Li
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ying-Ying Cheng
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhi-Tao Cui
- Department of Geriatrics, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Wei Jiang
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Wu-Qiong Zhang
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhong-Hua Du
- Department of Hematology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Bin Gao
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yin-Yin Xie
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hong-Mei Meng
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Adjemian J, Daniel-Wayman S, Ricotta E, Prevots DR. Epidemiology of Nontuberculous Mycobacteriosis. Semin Respir Crit Care Med 2018; 39:325-335. [PMID: 30071547 PMCID: PMC11037020 DOI: 10.1055/s-0038-1651491] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Annual prevalence estimates for pulmonary nontuberculous mycobacterial (PNTM) disease in the contiguous United States range from 1.4 to 13.9 per 100,000 persons, while one study found an annual prevalence of up to 44 per 100,000 persons in Hawaii. PNTM prevalence varies by region, sex, and race/ethnicity, with higher prevalence among women and persons of Asian ancestry, as well as in the Southern United States and Hawaii. Studies consistently indicate that PNTM prevalence is increasing, with estimates ranging from 2.5 to 8% per year. Most PNTM disease is associated with Mycobacterium avium complex (MAC), although the proportion of disease attributed to MAC varies by region. Host factors identified as influencing disease risk include structural lung disease, immunomodulatory medication, as well as variants in connective tissue, mucociliary clearance, and immune genes. Environmental variables including measures of atmospheric moisture and concentrations of certain soil factors have also been shown to correlate with higher PNTM prevalence. Prevalence of extrapulmonary NTM disease is lower, stable, and associated with different risk factors, including primary immune deficiencies or HIV infection.
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Affiliation(s)
- Jennifer Adjemian
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Commissioned Corps, United States Public Health Service, Rockville, Maryland
| | - Shelby Daniel-Wayman
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Emily Ricotta
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - D. Rebecca Prevots
- Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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