Mycobacterium aviumcomplex infection in non-cystic fibrosis bronchiectasis

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Abstract

Background and objective

Reliable markers of disease progression or stability to assist in management decisions are lacking in patients with non-cystic fibrosis bronchiectasis and Mycobacterium avium complex (MAC) infection.

Methods

Data from 52 adults with non-cystic fibrosis bronchiectasis and coexisting MAC infection managed at our institution over a 5-year period were retrospectively analysed. High-resolution computed tomography (HRCT) scans were scored using a scoring system that focused on findings associated with MAC infection.

Results

Chronic pulmonary aspergillosis was independently associated with mortality (hazard ratio (HR) = 8.916, 95% confidence interval (CI) = 1.324–60.027), as were nodules with cavitation (HR = 5.911, 95% CI = 1.095–25.911) and emphysema (HR = 1.027, 95% CI = 1.002–1.053) on HRCT. Anti-MAC chemotherapy was more likely to lead to MAC culture conversion (67% vs 27%, P = 0.005) but did not improve survival as compared with patients managed with observation. Longitudinally, patients who had improvements in HRCT scores were younger (60.2 ± 9.19 years vs 69.83 ± 12.43 years, P = 0.043), while the presence of cavitation within nodules predicted a deterioration in HRCT scores (0.5 (0–3) vs 0 (0–1), P = 0.033). No significant longitudinal differences were found in lung function in the cohort as a whole or within different groups.

Conclusions

Chronic pulmonary aspergillosis in patients with bronchiectasis and coexisting MAC infection is a strong predictor of mortality. Cavitation within nodules and emphysema on HRCT at presentation were independently associated with mortality.

SUMMARY AT A GLANCE

In patients with non-cystic fibrosis bronchiectasis and Mycobacterium avium complex infection, chronic pulmonary aspergillosis is a strong independent predictor of mortality, as are nodules with cavitation and emphysema on high-resolution computerized tomography (HRCT) scans at presentation. Longitudinally, the presence of cavitation within nodules predicted deterioration in HRCT scores.

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