Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease

for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC)

Research output: Contribution to journalArticle

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Abstract

Background There is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease. Methods We conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model. Results Mean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23%) required treatment and 50 (77%) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity (%FEV 1 ), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and % FEV 1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups. Conclusions Mild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.

Original languageEnglish
Article numbere0216034
JournalPloS one
Volume14
Issue number4
DOIs
Publication statusPublished - 2019 Apr 1

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Mycobacterium avium complex
Mycobacterium avium Complex
Pulmonary diseases
respiratory tract diseases
Lung Diseases
Bronchiectasis
Deterioration
Observation
lesions (animal)
body mass index
Therapeutics
Disease Progression
deterioration
Body Mass Index
Insertional Mutagenesis
retrospective studies
disease course
infection
transposons
Vital Capacity

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC) (2019). Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease. PloS one, 14(4), [e0216034]. https://doi.org/10.1371/journal.pone.0216034

Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease. / for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC).

In: PloS one, Vol. 14, No. 4, e0216034, 01.04.2019.

Research output: Contribution to journalArticle

for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC) 2019, 'Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease', PloS one, vol. 14, no. 4, e0216034. https://doi.org/10.1371/journal.pone.0216034
for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC). Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease. PloS one. 2019 Apr 1;14(4). e0216034. https://doi.org/10.1371/journal.pone.0216034
for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC). / Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease. In: PloS one. 2019 ; Vol. 14, No. 4.
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title = "Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease",
abstract = "Background There is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease. Methods We conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model. Results Mean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23{\%}) required treatment and 50 (77{\%}) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity ({\%}FEV 1 ), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and {\%} FEV 1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups. Conclusions Mild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.",
author = "{for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC)} and Yoshifumi Kimizuka and Yoshihiko Hoshino and Tomoyasu Nishimura and Takahiro Asami and Yumi Sakakibara and Kozo Morimoto and Shinji Maeda and Noboru Nakata and Takayuki Abe and Shunsuke Uno and Ho Namkoong and Hiroshi Fujiwara and Yohei Funatsu and Kazuma Yagi and Toshihide Fujie and Makoto Ishii and Naohiko Inase and Satoshi Iwata and Atsuyuki Kurashima and Tomoko Betsuyaku and Naoki Hasegawa",
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AU - for the Non-Tuberculous Mycobacteriosis-Japan Research Consortium (NTM-JRC)

AU - Kimizuka, Yoshifumi

AU - Hoshino, Yoshihiko

AU - Nishimura, Tomoyasu

AU - Asami, Takahiro

AU - Sakakibara, Yumi

AU - Morimoto, Kozo

AU - Maeda, Shinji

AU - Nakata, Noboru

AU - Abe, Takayuki

AU - Uno, Shunsuke

AU - Namkoong, Ho

AU - Fujiwara, Hiroshi

AU - Funatsu, Yohei

AU - Yagi, Kazuma

AU - Fujie, Toshihide

AU - Ishii, Makoto

AU - Inase, Naohiko

AU - Iwata, Satoshi

AU - Kurashima, Atsuyuki

AU - Betsuyaku, Tomoko

AU - Hasegawa, Naoki

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background There is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease. Methods We conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model. Results Mean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23%) required treatment and 50 (77%) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity (%FEV 1 ), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and % FEV 1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups. Conclusions Mild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.

AB - Background There is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease. Methods We conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model. Results Mean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23%) required treatment and 50 (77%) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity (%FEV 1 ), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and % FEV 1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups. Conclusions Mild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.

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