Clinical Characteristics and Prognosis of Nontuberculous Mycobacterial Lung Disease with Different Radiographic Patterns

• Published in: Lung 2011-12, Vol.189 (6), p.467-474
• Main Authors: Shu, Chin-Chung, Lee, Chih-Hsin, Hsu, Chia-Lin, Wang, Jann-Tay, Wang, Jann-Yuan, Yu, Chong-Jen, Lee, Li-Na
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Albumin; Bacterial infections; Blood; Bronchiectasis; C-reactive protein; C-Reactive Protein - metabolism; Comparative analysis; Epidemiology; Female; Humans; Kaplan-Meier Estimate; Leukocytes; Lung - microbiology; Lung diseases; Lung Diseases - diagnostic imaging; Lung Diseases - metabolism; Lung Diseases - microbiology; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Mycobacterium avium; Mycobacterium avium Complex - isolation & purification; Mycobacterium Infections, Nontuberculous - classification; Mycobacterium Infections, Nontuberculous - diagnostic imaging; Mycobacterium Infections, Nontuberculous - pathology; Pneumology/Respiratory System; Prognosis; Radiography; Retrospective Studies; Serum Albumin - metabolism; Sputum; Survival; Tuberculosis; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - pathology
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-011-9321-4

Rationale The clinical characteristics and prognostic impact of radiographic patterns of patients with nontuberculous mycobacterial lung disease (NTM-LD) are rarely evaluated. Design Patients with NTM-LD from 2007 to 2009 in a single medical center in Taiwan were identified. Their radiographic patterns were reviewed and classified into cavitary, bronchiectatic, or consolidative. They were also compared to patients with cavitary pulmonary tuberculosis (TB-LD). Results Of 481 NTM-LD patients identified, 62, 134, and 56 patients were categorized into cavitary, bronchiectatic, and consolidative groups, respectively. Compared with 180 TB-LD patients, cavitary NTM-LD had male predominance and was associated with higher grades of sputum acid-fast smear (3+ or 4+), prior pulmonary TB, and poor baseline pulmonary function. NTM-LD patients with consolidative pattern were likely to have underlying comorbidity, the highest blood leukocyte count and C-reactive protein, and lowest albumin. In all NTM-LD, the consolidative pattern was independently associated with poor prognosis for 6-month survival. Patients with cavitary Mycobacterium avium complex (MAC)-LD had worse 6-month survival than those with bronchiectatic pattern. Conclusion In Taiwan, NTM-LD patients with consolidative pattern have the worst prognosis while patients with cavitary pattern have worse survival than those with bronchiectasis in MAC-LD. Because varying radiographic patterns represent different prognoses, understanding the characteristics of NTM-LD patients with different radiographic patterns complements clinical practice.