Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis

Respirology. 2014 Jul;19(5):714-22. doi: 10.1111/resp.12287. Epub 2014 Apr 1.

Abstract

Background and objective: Reliable markers of disease progression or stability to assist in management decisions are lacking in patients with non-cystic fibrosis bronchiectasis and Mycobacterium avium complex (MAC) infection.

Methods: Data from 52 adults with non-cystic fibrosis bronchiectasis and coexisting MAC infection managed at our institution over a 5-year period were retrospectively analysed. High-resolution computed tomography (HRCT) scans were scored using a scoring system that focused on findings associated with MAC infection.

Results: Chronic pulmonary aspergillosis was independently associated with mortality (hazard ratio (HR) = 8.916, 95% confidence interval (CI) = 1.324-60.027), as were nodules with cavitation (HR = 5.911, 95% CI = 1.095-25.911) and emphysema (HR = 1.027, 95% CI = 1.002-1.053) on HRCT. Anti-MAC chemotherapy was more likely to lead to MAC culture conversion (67% vs. 27%, P = 0.005) but did not improve survival as compared with patients managed with observation. Longitudinally, patients who had improvements in HRCT scores were younger (60.2 ± 9.19 years vs. 69.83 ± 12.43 years, P = 0.043), while the presence of cavitation within nodules predicted a deterioration in HRCT scores (0.5 (0-3) vs. 0 (0-1), P = 0.033). No significant longitudinal differences were found in lung function in the cohort as a whole or within different groups.

Conclusions: Chronic pulmonary aspergillosis in patients with bronchiectasis and coexisting MAC infection is a strong predictor of mortality. Cavitation within nodules and emphysema on HRCT at presentation were independently associated with mortality.

Keywords: aspergillus lung disease; atypical mycobacterial disease; bronchiectasis; respiratory infection (non-tuberculous).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bronchiectasis / diagnostic imaging
  • Bronchiectasis / epidemiology*
  • Bronchiectasis / mortality*
  • Chronic Disease
  • Comorbidity
  • Disease Progression*
  • Female
  • Fibrosis
  • Humans
  • Kaplan-Meier Estimate
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mycobacterium avium Complex*
  • Mycobacterium avium-intracellulare Infection / diagnostic imaging
  • Mycobacterium avium-intracellulare Infection / epidemiology*
  • Mycobacterium avium-intracellulare Infection / mortality*
  • Predictive Value of Tests
  • Pulmonary Aspergillosis / complications*
  • Pulmonary Aspergillosis / diagnostic imaging
  • Pulmonary Emphysema / complications
  • Pulmonary Emphysema / diagnostic imaging
  • Radiography
  • Retrospective Studies
  • Risk Factors
  • Solitary Pulmonary Nodule / complications
  • Solitary Pulmonary Nodule / diagnostic imaging
  • Survival Rate
  • Tomography Scanners, X-Ray Computed