Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan.
Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
PLoS One. 2022 Jul 21;17(7):e0271660. doi: 10.1371/journal.pone.0271660. eCollection 2022.
The Mycobacterium abscessus complex (MABC) comprises rapidly growing mycobacteria and has received increasing attention recently, with an increasing number of associated infections reported worldwide. However, the clinical features of MABC pulmonary disease (MABC-PD), especially in terms of the chest computed tomography (CT) findings, are not fully understood. Thus, this retrospective, cross-sectional study aimed to evaluate the clinical background and chest high-resolution CT (HRCT) findings of MABC-PD in comparison with those of Mycobacterium avium complex PD (MAC-PD). Accordingly, 36 patients with MABC-PD and 65 patients with MAC-PD (defined according to the American Thoracic Society criteria), who were newly diagnosed at four major hospitals in Okinawa (Japan) between January 2012 and December 2017, were analyzed. With respect to their clinical background, only cardiovascular diseases were significantly more common in patients with MABC-PD than in those with MAC-PD (38.9% vs. 18.5%, p = 0.0245). HRCT revealed a significantly higher incidence of low attenuation in patients with MABC-PD than in those with MAC-PD (63.9% vs. 10.8%, p<0.0001). On analyzing only never-smokers (20 and 47 patients with MABC-PD and MAC-PD, respectively), this significant difference remained (65.0% vs. 8.5%, p<0.0001), suggesting MABC infection itself caused low attenuation. In terms of the distribution of abnormal shadows, the involvement of the right lower, left upper, and left lower lobes was more common in patients with MABC-PD than in those with MAC-PD. Furthermore, the mean number of involved lung lobes was significantly higher in patients with MABC-PD than in those with MAC-PD (5.6 vs. 4.7, p<0.001). Although further studies are needed, we assume that the aforementioned radiological features of MABC-PD are due to the high virulence of MABC.
分支杆菌脓肿复合体（MABC）由快速生长的分支杆菌组成，最近受到越来越多的关注，全球报道的相关感染病例也在不断增加。然而，MABC 肺部疾病（MABC-PD）的临床特征，特别是在胸部计算机断层扫描（CT）表现方面，尚未完全了解。因此，本回顾性、横断面研究旨在评估 MABC-PD 的临床背景和胸部高分辨率 CT（HRCT）表现，并与鸟分枝杆菌复合体 PD（MAC-PD）进行比较。为此，分析了 2012 年 1 月至 2017 年 12 月在冲绳（日本）的四家主要医院新诊断的 36 例 MABC-PD 患者和 65 例 MAC-PD 患者（根据美国胸科学会标准定义）。在临床背景方面，仅心血管疾病在 MABC-PD 患者中比在 MAC-PD 患者中更为常见（38.9%比 18.5%，p=0.0245）。HRCT 显示 MABC-PD 患者的低衰减发生率明显高于 MAC-PD 患者（63.9%比 10.8%，p<0.0001）。仅分析从不吸烟者（MABC-PD 和 MAC-PD 患者分别为 20 例和 47 例），这一显著差异仍然存在（65.0%比 8.5%，p<0.0001），提示 MABC 感染本身引起了低衰减。在异常阴影分布方面，MABC-PD 患者的右下、左上和左下肺叶受累更为常见。此外，MABC-PD 患者受累肺叶数明显高于 MAC-PD 患者（5.6 比 4.7，p<0.001）。尽管需要进一步研究，但我们假设 MABC-PD 的上述影像学特征是由于 MABC 的高毒力所致。
