Mycobacterium Avium Complex (MAC) Lung Disease in Two Inner City Community Hospitals: Recognition, Prevalence, Co-Infection with Mycobacterium Tuberculosis (MTB) and Pulmonary Function (PF) Improvements After Treatment.
Mycobacterium Avium Complex (MAC) Lung Disease in Two Inner City Community Hospitals: Recognition, Prevalence, Co-Infection with Mycobacterium Tuberculosis (MTB) and Pulmonary Function (PF) Improvements After Treatment.
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DOI：
10.2174/1874306401004010076
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发表时间：
2010-08-08
期刊：
影响因子：
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通讯作者：
Donath, Joseph
中科院分区：
文献类型：
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作者：
Khan, Zinobia;Miller, Albert;Donath, Joseph
简介：本研究的目的是分离MAC肺疾病的殖民化，并确定适应症treatment.MATERIALS和METHODOLOGY：在4年多的时间里，我们评估了患者谁有积极的MAC文化，MAC感染和合并感染结核分枝杆菌。在第一项研究中，42例免疫功能正常的患者痰或BAL培养阳性MAC在一年内（2004年）进行了审查。在临床和影像学审查中，将其分类为与MAC相关、可能与MAC相关或与MAC无关的疾病。在第二项研究中，我们回顾了两年内（2004-2005年）所有免疫功能正常的患者，其呼吸道分泌物培养结核分枝杆菌和非结核分枝杆菌（NTM）。在最后一项研究中，我们评估了MAC感染患者治疗前后的肺功能（PF）（2006- 2007年）。根据ATS guidelines.RESULTS：肺疾病与MAC相关/可能相关21例（50%），不相关21例（50%）。在MAC相关肺部疾病患者中，主治医生不考虑诊断，除非该医生是肺病学家。MAC相关肺病患者中有一半是吸烟者，白色和美国出生的。有12名免疫功能正常的患者进行了MTB和NTM培养。其中11人是非白人，都是外国出生的。表现和临床病程与MTB一致。所有8例PF异常的患者均得到改善。结论：在两个市中心医院，MAC肺部感染的患病率是结核病的4倍。当只有一次痰培养阳性时，MAC感染的治疗适应症还应严重依赖于临床和放射学证据。只有当住院医生是肺病学家时，才考虑诊断。大多数合并感染的患者在临床上与MTB一致，并对单独抗MTB治疗有反应。在PF开始异常的患者中，抗MAC治疗可改善PF。
INTRODUCTION: The purpose of this study was to separate MAC lung disease from colonization and to define indications for treatment.MATERIALS AND METHODOLOGY: Over 4 years, we evaluated patients who had positive MAC cultures, MAC infection and coinfection with MTB. In the first study, 42 immunocompetent patients with sputum or BAL culture positive only for MAC during a single year (2004) were reviewed. On clinical and radiographic review, they were classified as disease related to MAC, likely related to MAC or unrelated to MAC. In the second study, we reviewed all immunocompetent patients, during two years (2004-2005), whose respiratory secretions cultured both MTB and nontuberculous mycobacteria (NTM). In the last study, we evaluated pulmonary function (PF) in patients with MAC infection before and after therapy (2006- 2007). PF was evaluated in patients following ATS guidelines.RESULTS: Lung disease was related/likely related to MAC in 21 patients (50%) and not related in 21 (50%). In patients with MAC-related lung disease, the primary physician did not consider the diagnosis except when that physician was a pulmonologist. Half of those with MAC-related lung disease were smokers, white and US-born. There were 12 immunocompetent patients with MTB and NTM cultures. Eleven were non-white and all were foreign-born. Presentation and clinical course were consistent with MTB. All 8 patients with abnormal PF improved.CONCLUSIONS: The prevalence of MAC lung infection in two inner city hospitals was four times higher than that of TB. The indication for treatment of MAC infection should also rely heavily on clinical and radiological evidence when there is only one positive sputum culture. The diagnosis was considered only when the admitting physician was a pulmonologist. Most patients with combined infection were clinically consistent with MTB and responded to anti MTB treatment alone. Treatment with anti-MAC therapy improved PF in those patients whose PF was abnormal to begin with.