Henkle Emily, Novosad Shannon A, Shafer Sean, Hedberg Katrina, Siegel Sarah A R, Ku Jennifer, Varley Cara, Prevots D Rebecca, Marras Theodore K, Winthrop Kevin L
1 OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon.
2 Public Health Division, Oregon Health Authority, Portland, Oregon.
Ann Am Thorac Soc. 2017 Jul;14(7):1120-1128. doi: 10.1513/AnnalsATS.201610-801OC.
The natural history of nontuberculous mycobacteria (NTM) respiratory infection in the general population is poorly understood.
To describe the long-term clinical, microbiologic, and radiographic outcomes of patients with respiratory NTM isolates.
We previously identified a population-based cohort of patients with respiratory NTM isolation during 2005-2006 and categorized patients as cases or noncases using the American Thoracic Society/Infectious Diseases Society of America pulmonary NTM disease criteria at that time. During 2014-2015, we reviewed medical charts of patients alive on January 1, 2007. Outcomes of interest were the proportion of baseline noncases who later met case criteria and the proportions of patients with culture conversion or findings consistent with persistent disease at least 2-5 years and at least 5 years after first isolation. We defined disease persistence radiographically as infiltrate, nodules, or cavities and microbiologically as a positive respiratory mycobacterial culture. We used logistic regression to evaluate factors associated with evidence of persistence.
The study included 172 patients (62% of 278 eligible); those not included either refused consent (n = 47) or were not located (n = 56). One hundred two (59%) included patients met case criteria at baseline. Mycobacterium avium complex was commonly isolated among baseline cases (n = 91 [89%]) and noncases (n = 52 [74%]). Overall, 57 (55%) baseline cases had died, as compared with 43 (61%) noncases (P = 0.47). Among baseline noncases, only four (5.7%) later met case criteria. Overall, 55 (54%) baseline cases and 6 (9%) noncases initiated NTM treatment. Among cases, cultures were converted in 25 (64.1%) treated versus 4 (40%) untreated patients (P = 0.04). Of 89 cases alive 2 years after isolation, 61 (69%) had additional radiography, and 35 (39%) had respiratory cultures. Of these individuals, 54 (89%) had radiographic evidence and 17 (49%) had microbiologic evidence of disease persistence. At 5 years after first isolation these figures were 36 (82%) and 13 (54%), respectively. Women were more likely to have persistent radiographic findings and microbiologic persistence, and patients with chronic obstructive pulmonary disease were less likely to have microbiologic persistence.
In the general population, follow-up beyond 2 years of patients with respiratory NTM isolation is limited. Among those with additional evaluations, at least half of individuals have persistent positive cultures or radiographic findings consistent with NTM at least 2 years after isolation.
普通人群中非结核分枝杆菌（NTM）呼吸道感染的自然病史了解甚少。
描述呼吸道分离出NTM的患者的长期临床、微生物学和影像学结局。
我们先前确定了一个基于人群的队列，这些患者在2005 - 2006年期间呼吸道分离出NTM，并根据当时美国胸科学会/美国传染病学会的肺部NTM疾病标准将患者分类为病例或非病例。在2014 - 2015年期间，我们回顾了2007年1月1日仍在世患者的病历。感兴趣的结局是基线非病例中后来符合病例标准的比例，以及首次分离后至少2 - 5年和至少5年时培养转阴或有与持续性疾病相符的检查结果的患者比例。我们将影像学上的疾病持续定义为浸润、结节或空洞，微生物学上定义为呼吸道分枝杆菌培养阳性。我们使用逻辑回归来评估与持续性证据相关的因素。
该研究纳入了172例患者（278例符合条件者中的62%）；未纳入的患者要么拒绝同意（n = 47），要么无法找到（n = 56）。102例（59%）纳入患者在基线时符合病例标准。鸟分枝杆菌复合群在基线病例（n = 91 [89%]）和非病例（n = 52 [74%]）中均常见。总体而言，57例（55%）基线病例死亡，相比之下，43例（61%）非病例死亡（P = 0.47）。在基线非病例中，只有4例（5.7%）后来符合病例标准。总体而言,55例（54%）基线病例和6例（9%）非病例开始接受NTM治疗。在病例中，25例（64.1%）接受治疗的患者培养转阴，而4例（40%）未治疗患者培养转阴（P = 0.04）。在分离后2年仍存活的89例病例中，61例（69%）进行了额外的影像学检查，35例（39%）进行了呼吸道培养。在这些个体中，54例（89%）有疾病持续的影像学证据，17例（49%）有微生物学证据。首次分离后5年时，这些数字分别为36例（82%）和13例（54%）。女性更有可能有持续性的影像学表现和微生物学持续性，而慢性阻塞性肺疾病患者微生物学持续性的可能性较小。
在普通人群中，呼吸道分离出NTM的患者随访超过2年的情况有限。在那些进行了额外评估的患者中，至少一半的个体在分离后至少2年有持续的阳性培养或与NTM相符的影像学表现。
