Background
Methods
Study population
Diagnosis of NTM lung disease and definition of newly isolated NTM species
Follow up and treatment
Clinical and radiographic examination
Microbiological examination
Statistical analysis
Results
Characteristics of patients
Patients, No. |
N = 16 |
---|---|
Age, years, median (IQR) | 69 (61.7-73.5) |
Sex, female | 12 (75.0%) |
BMI, kg/m2, median (IQR) | 20.8 (19.2-21.4) |
Never smoker | 14 (87.5%) |
History of tuberculosis | 6 (37.5%) |
Underlying disease | |
Connective tissue disease | 4 (25.0%) |
Diabetes | 3 (18.7%) |
Malignancy | 1 (6.0%) |
Respiratory symptoms | |
Sputum | 16 (100%) |
Cough | 13 (81.2%) |
Dyspnea | 4 (25.0%) |
Hemoptysis | 3 (18.7%) |
General symptoms | |
Weight loss | 2 (12.5%) |
Night sweating | 1 (6.2%) |
Laboratory findings, median (IQR) | |
Leukocytes (×103/μl) | 6880 (5070-7542) |
Hemoglobin (g/dl) | 12.6 (11.9-13.3) |
Cholesterol | 168 (149-187.7) |
Albumin | 4 (3.8-4.4) |
Creatinine | 0.7 (0.6-0.9) |
Changes of NTM species during or after treatment for NTM lung disease
N = 16 | |
---|---|
M. avium complex → M. abscessus subspecies abscessus
| 7 (43.8%) |
M. intracellulare → M. abscessus subspecies abscessus
| 4 |
M. avium → M. abscessus subspecies abscessus
| 3 |
M. abscessus subspecies massiliense → M. avium complex
| 5 (31.2%) |
M. abscessus subspecies massiliense → M. avium
| 3 |
M. abscessus subspecies massiliense → M. intracellulare
| 2 |
Others | |
M. avium → M. fortuitum
| 1 (6.2%) |
M. avium → M. intracellulare
| 1 (6.2%) |
M. intracellulare → M. chimera
| 1 (6.2%) |
M. abscessus subspecies massiliense → M. abscessus subspecies abscessus
| 1 (6.2%) |
Changes of radiographic severities throughout treatment of initial NTM lung diseases and isolation of new NTM
At initiation of treatment | At 6–12 months after treatment | At isolation of new NTM | At 6–12 months after isolation of new NTM |
P Value | |
---|---|---|---|---|---|
Bronchiectasis, | |||||
Severity | 1.7 (1-2) | 1.8 (1.2-2) | 2 (1.2-2) | 1.7 (1.3-2) | .572 |
Extent | 1 (1-2) | 1 (1-2) | 1 (1-2) | 1 (1-2) | .733 |
Mucus plugging | 1 (0-1) | 0 (0-1) | 1 (0-1) | 1 (0-1) | .875 |
Cellular bronchiolitis | |||||
Severity | 1.8 (1.6-2.2) | 1.7 (1.2-2) | 2 (1.6-2) | 1.8 (1.7-2) | .089 |
Extent | 3 (1-3) | 2.5 (1-3) | 2 (1.5-3) | 2 (1-3) | .112 |
Cavity | |||||
Diameter (cm) | 1 (0-2) | 0 (0-1) | 1 (0-1) | 1 (0-2) | .245 |
Wall thickness (mm) | 2 (0-2.5) | 0 (0-2.1) | 2 (0-2) | 0.5 (0-2.4) | .978 |
Extent | 1 (0-1) | 0 (0-1) | 1 (0-1) | 1 (0-1) | 1.000 |
Nodules | 1 (0-1) | 1 (0.8-1) | 1 (1-1.5) | 1 (0-1) | .572 |
Consolidation | 0 (0-1) | 0 (0-0.3) | 0 (0-1) | 1 (0-1) | .479 |
Total CT score | 13.2 (7.2-17.6) | 9.6 (6.4-14.4) | 12.9 (9.0-14.8) | 13 (8.0-14.6) | .794 |
Changes of respiratory symptoms with isolation of new NTM species
No | NTM spices | Symptom changes at isolation of new NTM | Radiographic changes at isolation of new NTM | Clarithromycin resistance for initial NTM (MIC, μg/ml) | Clarithromycin resistance for new NTM(MIC, μg/ml) | Timing of new NTM isolation | Treatment for newly isolated NTM |
---|---|---|---|---|---|---|---|
M. avium complex → M. abscessus subspecies abscessus
| |||||||
1 |
M. intracellulare → M. abscessus subspecies abscessus
| Worsening | Worsening | Susceptible (1) | Inducible resistance (1, 64) | After treatment for initial NTM | Not started |
2 |
M. intracellulare → M. abscessus subspecies abscessus
| Worsening | Unchanged | Susceptible (2) | Inducible resistance (2, 64) | During treatment for initial NTM |
aStarted |
`3 |
M. intracellulare → M. abscessus subspecies abscessus
| Worsening | Worsening | Susceptible (2) | Inducible resistance (2, 8) | After treatment for initial NTM | Not started |
4 |
M. intracellulare → M. abscessus subspecies abscessus
| Worsening | Worsening | Susceptible (2) | Inducible resistance (0.5, 64) | After treatment for initial NTM | Not started |
5 |
M. avium → M. abscessus subspecies abscessus
| Unchanged | Unchanged | Susceptible (4) | Inducible resistance (0.5, 64) | During treatment for initial NTM | Not started |
6 |
M. avium → M. abscessus subspecies abscessus
| Worsening | Worsening | Susceptible (1) | Inducible resistance (1, 64) | During treatment for initial NTM | Continued on-going treatment |
7 |
M. avium → M. abscessus subspecies abscessus
| Worsening | Unchanged | Susceptible (0.5) | Inducible resistance (1, 64) | During treatment for initial NTM | Modified regimen and continued treatment |
M. abscessus subspecies massiliense → M. avium complex | |||||||
8 |
M. abscessus subspecies massiliense → M. intracellulare
| Unchanged | Unchanged | Susceptible (0.5) | N/A | During treatment for initial NTM | Modified regimen and continued treatment |
9 |
M. abscessus subspecies massiliense → M. intracellulare
| Unchanged | Worsening | Susceptible (0.5) | Susceptible (1) | During treatment for initial NTM | Modified regimen and continued treatment |
10 |
M. abscessus subspecies massiliense → M. avium
| Unchanged | Unchanged | Susceptible (0.5) | Resistance (64) | During treatment for initial NTM | Continued on-going treatment |
11 |
M. abscessus subspecies massiliense → M. avium
| Unchanged | Improving | Susceptible (0.5) | Susceptible (2) | During treatment for initial NTM | Modified regimen and continued treatment |
12 |
M. abscessus subspecies massiliense → M. avium
| Unchanged | Unchanged | N/A | N/A | During treatment for initial NTM |
aStarted |
Others | |||||||
13 |
M. avium → M. fortuitum
| Unchanged | Improving | Susceptible (0.5) | Inducible resistance (0.5, 16) | During treatment for initial NTM | Not started |
14 |
M. avium → M. intracellulare
| Worsening | Worsening | N/A | Susceptible (1) | After treatment for initial NTM | Started |
15 |
M. intracellulare → M. chimerae
| Improving | Worsening | Susceptible (1) | Susceptible (2) | During treatment for initial NTM | Continued on-going treatment |
16 |
M. abscessus subspecies massiliense → M. abscessus subspecies abscessus
| Unchanged | Worsening | Susceptible (0.5) | Inducible resistance (1, 16) | During treatment for initial NTM | Continued on-going treatment |