Clinical characteristics and early outcomes of patients newly diagnosed with pulmonary Mycobacterium avium complex disease

• Published in: Respiratory investigation 2019-01, Vol.57 (1), p.54-59
• Main Authors: Hagiwara, Eri, Katano, Takuma, Isomoto, Kohsuke, Otoshi, Ryota, Yamakawa, Hideaki, Okuda, Ryo, Sekine, Akimasa, Baba, Tomohisa, Komatsu, Shigeru, Ogura, Takashi
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Antibiotics, Antitubercular - administration & dosage; Antibodies, Bacterial - blood; Biomarkers - blood; Clarithromycin - administration & dosage; Culture conversion; Female; Humans; Immunoglobulin A - blood; Incidental Findings; Male; Middle Aged; Mycobacterium avium complex; Mycobacterium avium Complex - immunology; Mycobacterium avium-intracellulare Infection - diagnosis; Mycobacterium avium-intracellulare Infection - drug therapy; Mycobacterium avium-intracellulare Infection - epidemiology; Mycobacterium avium-intracellulare Infection - microbiology; Newly diagnosed patients; Predictive variables; Radiography, Thoracic; Retrospective Studies; Treatment Outcome; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - microbiology; Young Adult
• ISSN: 2212-5345; 2212-5353
• DOI: 10.1016/j.resinv.2018.08.006

The incidence of asymptomatic pulmonary Mycobacterium avium complex (MAC) disease appears to be increasing. This study aimed to determine the clinical characteristics and examine early outcomes of patients newly diagnosed with MAC disease. We retrospectively reviewed the medical records of all 184 patients newly diagnosed with MAC disease between April 2013 and March 2015 at our hospital. Culture conversion, defined as at least two consecutive negative cultures, was used as the early outcome measure. Of 184 patients, 45 were male and 139 were female, with a mean age of 70 years. Abnormal chest shadow found during an annual health check-up (58 patients) or incidentally during visits for other diseases (72 patients), was the major reason for referral to hospital, typically with no symptoms. Anti-MAC IgA antibody was positive in 64.5% of patients, and the positive rate was associated with the extent of lesions. Clarithromycin-based multi-drug chemotherapy was initiated in 111 patients. Culture conversion was achieved in 61 of 82 (74.4%) patients who were able to continue multi-drug chemotherapy. Patients who achieved culture conversion were more likely to be younger, female, and have a lower smear grade and nodular-bronchiectatic type. Multivariate logistic regression analysis identified patient age and smear grade as predictive variables. Abnormal chest shadow found during health check-up was the major reason for hospital visits, and most were asymptomatic. Culture conversion was achieved in three-fourths of patients treated, and was associated with age and smear grade, supporting early intervention at a younger age.