Non-tuberculous mycobacterial lung diseases: Retrospective analysis of 42 cases

Abstract

Objective: Non-tuberculosis mycobacterium (NTM) infections are particularly common in patients with AIDS and also in immuncompromised patients. The present study was designed to analyse retrospectively 42 cases with non-tuberculous mycobacterial lung infection. Material and Methods: A total of 42 patients [mean (standard deviation-SD); age 46.69 (14.57) years, 37 (88.1%) males] diagnosed with NTM lung infection were included in this retrospective descriptive study, during their follow up at the İstanbul University İstanbul Faculty of Medicine, Süreyyapaşa Chest Diseases and Chest Surgery Training and Research Hospital and Yedikule Chest Diseases and Chest Surgery Training and Research Hospital clinics, between 2004 and 2010. Identification was performed with Hsp65PCRREA. Data on therapeutic management, radiological and bacteriological findings, co-morbidities and treatment outcomes were obtained from medical records, direct phone calls to patients and tuberculosis dispensaries. Results: The most frequently identified NTM types were Mycobacterium abscessus, Mycobacterium avium and Mycobacterium kansasii [n=14 (33.3%), 9 (21.4%) and 8 (19.0%), respectively]. Co-morbidities were identified in 20 (47.6%) [respiratory in 11 (26.2%) and non-respiratory in 9 (21.4%)] patients. Chest x-ray revealed cavity in 27 (63.4%), segmental or subsegmental homogenous opacities in 23 (57.8%) and focal acinar, alveolar, micronodular opacities in 23 (57.8%) patients; 27 (64.3%) cases had bilateral involvement. Drug sensitivity testing for first-line drugs performed in 30 (71.4%) patients revealed isoniazide+rifampicin resistance in 18 (60.0%) patients, while drug sensitivity testing for second-line drugs was performed in 16 (38.1%) patients. Treatment outcome was cure in 26 (61.9%) patients, treatment failure in 2 (4.8%), death in 3 (7.1%), ongoing treatment in 5 (11.9%) and follow-up without treatment in 5 (11.9%) patients, while 1 (2.4%) patient stopped treatment. Conclusion: Identification of the mycobacterium type in patients with pulmonary TDM infection is essential for correct diagnosis and best treatment planning in addition to obtaining real-life epidemiologic data in Turkey. Lack of identification of the mycobacterium delays the diagnosis and causes resistance development in TDM patients. In patients with TDM infection, treatment should be planned based on both clinical and bacteriological findings. © 2013 by Türkiye Klinikleri.