Markers indicating deterioration of pulmonary Mycobacterium avium-intracellulare infection

• Published in: American journal of respiratory and critical care medicine 1999-12, Vol.160 (6), p.1851-1855
• Main Authors: YAMAZAKI, Y, KUBO, K, TAKAMIZAWA, A, YAMAMOTO, H, HONDA, T, SONE, S
• Format: Article
• Language: English
• Subjects: Aged; Bacterial diseases; Biological and medical sciences; Blood Sedimentation; Body Mass Index; Bronchoalveolar Lavage Fluid - cytology; C-Reactive Protein - analysis; CA-19-9 Antigen - analysis; Disease Progression; Female; Human bacterial diseases; Humans; Infectious diseases; Lung - diagnostic imaging; Male; Medical sciences; Middle Aged; Mycobacterium avium-intracellulare Infection - diagnosis; Mycobacterium avium-intracellulare Infection - diagnostic imaging; Retrospective Studies; Sputum - microbiology; Tomography, X-Ray Computed; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - diagnostic imaging
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.160.6.9902019

To predict the natural history of pulmonary Mycobacterium avium-intracellulare (MAI) infection with nodular bronchiectasis, we retrospectively evaluated clinical manifestations, laboratory data, and bronchoalveolar lavage fluid (BALF) findings in 57 patients. The patients received follow-up chest computed tomographic scans and testing for sputum bacteriology between intervals of at least 12 mo. They were divided into two groups after observation for 28 +/- 13 mo: deteriorated (n = 34) and not-deteriorated (n = 23). There were no patients with spontaneous improvement. At the start of observation, the mean age was greater in the deteriorated group (69 +/- 9 yr) than in the not-deteriorated group (57 +/- 9 yr). The mean body-mass index was lower in the deteriorated group (19.2 +/- 3.1 kg/m(2)) than in the not-deteriorated group (21.5 +/- 1.5 kg/m(2)). C-reactive protein, erythrocyte sedimentation rate, and carbohydrate antigen 19-9 were significantly elevated in the deteriorated group. The BALF findings of the deteriorated group showed that the neutrophil cell counts were significantly increased. Thirty-four of 57 patients with pulmonary MAI infection with nodular bronchiectasis had progressive clinical and/or radiographic disease. The older and thinner patients tended to become worse. Neutrophil-related inflammation associated with a decrease in CD4+ lymphocyte might reflect the progression of pulmonary MAI infection with nodular bronchiectasis.