Pulmonary Nontuberculous Mycobacterial Disease Prevalence and Clinical Features An Emerging Public Health Disease
Pulmonary Nontuberculous Mycobacterial Disease Prevalence and Clinical Features An Emerging Public Health Disease
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DOI：
10.1164/rccm.201003-0503oc
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发表时间：
2010-10-01
影响因子：
24.7
通讯作者：
Hedberg, Katrina
中科院分区：
文献类型：
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作者：
Winthrop, Kevin L.;McNelley, Erin;Hedberg, Katrina
基本原理呼吸道标本中的非结核分枝杆菌（NTM）越来越常见;然而，肺部疾病的患病率尚不清楚。目的：确定NTM疾病的患病率、临床特征和危险因素，并检查美国胸科学会（ATS）/美国传染病学会（IDSA）肺部NTM病例定义的微生物学标准对真正NTM疾病的预测价值。方法：我们确定了所有俄勒冈州居民在2005-2006年期间至少有一个呼吸道分枝杆菌分离。从这些患者的人群为基础的子集，我们收集了临床和放射学信息，并使用ATS/IDSA肺NTM疾病标准来定义diseases. Measures和主要结果：在2年的时间内，807俄勒冈州有一个或多个呼吸NTM分离。407例（50%）居住在波特兰大都市地区，其中283例（70%）有可评价的临床记录。在有记录的人群中，134例（47%）符合ATS/IDSA肺NTM疾病标准，2年期间的最低总患病率为8.6/100，000人，波特兰地区至少50岁的人群为20.4/100，000人。病例受试者年龄为66岁（中位数;范围，12-92岁），常见女性（59%），大多数疾病由鸟分枝杆菌复合体引起（88%）。常见的有空洞（24.5%）、支气管扩张（16%）、慢性阻塞性肺疾病（28%）和免疫抑制治疗（25.5%）。符合ATS/IDSA疾病微生物学标准的86%的患者也符合完整的ATS/IDSA疾病标准。结论：呼吸道NTM分离株经常代表疾病。肺部NTM疾病并不罕见，尤其是在老年女性中。ATS/IDSA微生物学标准对疾病具有高度预测性，可用于基于实验室的NTM疾病监测。
Rationale Respiratory specimens with nontuberculous mycobacteria (NTM) are increasingly common; however, pulmonary disease prevalence is unknown.Objectives: To determine the disease prevalence, clinical features, and risk factors for NTM disease, and to examine the predictive value of the microbiologic criteria of the American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) pulmonary NTM case definition for true NTM disease.Methods: We identified all Oregon residents during 2005-2006 with at least one respiratory mycobacterial isolate. From a population-based subset of these patients, we collected clinical and radiologic information and used the ATS/IDSA pulmonary NTM disease criteria to define disease.Measurements and Main Results: In the 2-year time period, 807 Oregonians had one or more respiratory NTM isolates. Four hundred and seven (50%) resided within the Portland metropolitan region, among which 283 (70%) had evaluable clinical records. For those with records, 134 (47%) met ATS/IDSA pulmonary NTM disease criteria for a minimum overall 2-year period prevalence of 8.6/100,000 persons, and 20.4/100,000 in those at least 50 years of age within the Portland region. Case subjects were 66 years of age (median; range, 12-92 yr), frequently female (59%), and most with disease caused by Mycobacterium avium complex (88%). Cavitation (24.5%), bronchiectasis (16%), chronic obstructive pulmonary disease (28%), and immunosuppressive therapy (25.5%) were common. Eighty-six percent of patients meeting the ATS/IDSA microbiologic criteria for disease also met the full ATS/IDSA disease criteria.Conclusions: Respiratory NTM isolates frequently represent disease. Pulmonary NTM disease is not uncommon, particularly among elderly females. The ATS/IDSA microbiologic criteria are highly predictive of disease and could be useful for laboratory-based NTM disease surveillance.