Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
18
06
2018
accepted:
14
04
2019
entrez:
26
4
2019
pubmed:
26
4
2019
medline:
9
1
2020
Statut:
epublish
Résumé
There is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease. We conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model. Mean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23%) required treatment and 50 (77%) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity (%FEV1), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and %FEV1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups. Mild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.
Sections du résumé
BACKGROUND
There is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease.
METHODS
We conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model.
RESULTS
Mean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23%) required treatment and 50 (77%) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity (%FEV1), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and %FEV1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups.
CONCLUSIONS
Mild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.
Identifiants
pubmed: 31022253
doi: 10.1371/journal.pone.0216034
pii: PONE-D-18-18115
pmc: PMC6483267
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0216034Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Clin Microbiol. 2009 Jul;47(7):2156-64
pubmed: 19403768
Am Rev Respir Dis. 1990 Oct;142(4):858-62
pubmed: 2221593
Int J Tuberc Lung Dis. 2012 Oct;16(10):1393-9
pubmed: 23107637
Int J Tuberc Lung Dis. 2012 May;16(5):660-4
pubmed: 22410245
Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416
pubmed: 17277290
Clin Infect Dis. 2000 Oct;31(4):958-67
pubmed: 11049777
Clin Infect Dis. 2009 Aug 15;49(4):529-35
pubmed: 19591595
Am J Respir Crit Care Med. 2010 Oct 1;182(7):970-6
pubmed: 20538958
Respir Med. 2014 Mar;108(3):417-25
pubmed: 24484653
PLoS One. 2016 Feb 09;11(2):e0148917
pubmed: 26859598
Ann Am Thorac Soc. 2014 Jan;11(1):45-53
pubmed: 24251904
Chest. 2012 Jan;141(1):190-197
pubmed: 21724552
Am J Respir Crit Care Med. 1998 Oct;158(4):1235-44
pubmed: 9769287
Kekkaku. 2012 Jun;87(6):461-7
pubmed: 22834098
Ann Am Thorac Soc. 2014 Jan;11(1):1-8
pubmed: 24102151
Int J Tuberc Lung Dis. 2010 Sep;14(9):1201-4
pubmed: 20819269
Kekkaku. 2012 Nov;87(11):687-95
pubmed: 23367826
Microbiology. 2010 Feb;156(Pt 2):496-504
pubmed: 19850613
Emerg Infect Dis. 2016 Jun;22(6):1116-7
pubmed: 27191735
J Med Microbiol. 2009 Jul;58(Pt 7):945-50
pubmed: 19502362
Am J Respir Crit Care Med. 2012 Apr 15;185(8):881-6
pubmed: 22312016
Emerg Infect Dis. 2010 Oct;16(10):1576-83
pubmed: 20875283
Chest. 2009 Dec;136(6):1569-1575
pubmed: 19542259
Emerg Infect Dis. 2009 Oct;15(10):1562-9
pubmed: 19861046
Kekkaku. 2013 Jan;88(1):23-7
pubmed: 23513565
Ann Am Thorac Soc. 2013 Aug;10(4):299-306
pubmed: 23952847
AJR Am J Roentgenol. 2013 Oct;201(4):764-72
pubmed: 24059365
PLoS One. 2015 Feb 11;10(2):e0117797
pubmed: 25671431
Microb Pathog. 1989 Oct;7(4):263-78
pubmed: 2695739
AJR Am J Roentgenol. 2008 Oct;191(4):W160
pubmed: 18806143
Am J Respir Crit Care Med. 2012 Mar 1;185(5):575-83
pubmed: 22199005
Kekkaku. 2012 Jul;87(7):491-9
pubmed: 22993890