Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel.
Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
J Cyst Fibros. 2015 Jan;14(1):53-62. doi: 10.1016/j.jcf.2014.05.008. Epub 2014 Jun 7.
Nontuberculous mycobacteria (NTM) are emerging infections in the CF population.
To assess NTM infection prevalence and associated features in our CF clinic population.
Patient records, 2002-2011, were reviewed for NTM infection. FEV1, pancreatic function, sputum microbiology, and serum cytokines were compared in patients with and without NTM infection.
Incidence rate of NTM infection increased from 0 in 2002 to 8.7% in 2011 (p<0.001). NTM infection prevalence increased 3-fold from 5% (4/79) in 2003 to 14.5% (16/110) in 2011 (p=0.05). Prevalence of chronic NTM lung disease has decreased somewhat since a peak in 2009, with institution of aggressive triple therapy. Of NTM-infected compared to uninfected patients, 88.2% vs. 60.3% had a known 'severe' CFTR genotype (p=0.04), 88.2% vs. 58.9% were pancreatic insufficient (p=0.02); 70.6% vs. 43.8% had chronic Pseudomonas aeruginosa (p=0.06); 75% vs. 32% had Aspergillus infection (p=0.007) and 23.5% vs 2.7% had allergic bronchopulmonary aspergillosis (p=0.01). Patients infected with Mycobacterium abscessus had increased TGF-β, TNF-α, IL-1β, IL-2, IL-4 and IL-5 levels (p<0.05). There was no difference in cytokine levels for all NTM infected compared to uninfected patients. M. abscessus comprised 46% of all NTM infections. Comparing M. abscessus versus other NTM, duration was 10.5 (1-118) months versus 1 (1-70) month, median (range) (p=0.004); lung disease occurred in 69% versus 17% (p=0.0004), with sputum conversion in 4/11 versus 5/6, respectively (NS).
NTM incidence and prevalence have increased dramatically in our CF clinic, associated with a severe CF genotype and phenotype. M. abscessus, the most prevalent NTM, caused prolonged infection despite therapy. There has been some decrease in the prevalence of NTM lung disease since 2009.
非结核分枝杆菌（NTM）是 CF 人群中新兴的感染。
评估我们 CF 诊所人群中 NTM 感染的流行率和相关特征。
对 2002 年至 2011 年的患者记录进行了回顾性分析，以评估 NTM 感染情况。比较了有和没有 NTM 感染的患者的 FEV1、胰腺功能、痰微生物学和血清细胞因子。
NTM 感染的发病率从 2002 年的 0 增加到 2011 年的 8.7%（p<0.001）。NTM 感染的患病率从 2003 年的 5%（4/79）增加到 2011 年的 14.5%（16/110）（p=0.05）。自 2009 年开始采用积极的三联疗法以来，慢性 NTM 肺部疾病的患病率有所下降。与未感染患者相比，88.2%的 NTM 感染患者与 60.3%的患者具有已知的“严重”CFTR 基因型（p=0.04），88.2%的患者与 58.9%的患者胰腺功能不足（p=0.02）；70.6%的患者与 43.8%的患者患有慢性铜绿假单胞菌（p=0.06）；75%的患者与 32%的患者感染烟曲霉（p=0.007），23.5%的患者与 2.7%的患者患有变应性支气管肺曲霉病（p=0.01）。感染脓肿分枝杆菌的患者 TGF-β、TNF-α、IL-1β、IL-2、IL-4 和 IL-5 水平升高（p<0.05）。与所有 NTM 感染患者相比，细胞因子水平无差异。脓肿分枝杆菌占所有 NTM 感染的 46%。与其他 NTM 相比，脓肿分枝杆菌的持续时间为 10.5（1-118）个月与 1（1-70）个月，中位数（范围）（p=0.004）；肺部疾病的发生率为 69%与 17%（p=0.0004），痰转阴率分别为 4/11 与 5/6，无差异（NS）。
我们的 CF 诊所 NTM 的发病率和患病率显著增加，与严重的 CF 基因型和表型有关。脓肿分枝杆菌是最常见的 NTM，尽管进行了治疗，但仍会导致感染持续存在。自 2009 年以来，NTM 肺部疾病的患病率有所下降。
