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Mycobacterium avium complex infection in non‐cystic fibrosis bronchiectasis
Author(s) -
Zoumot Zaid,
Boutou Afroditi K.,
Gill Simon S.,
Zeller Mafalda,
Hansell David M.,
Wells Athol U.,
Wilson Robert,
Loebinger Michael R.
Publication year - 2014
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12287
Subject(s) - bronchiectasis , medicine , culture conversion , cystic fibrosis , hazard ratio , high resolution computed tomography , gastroenterology , lung , fibrosis , aspergillosis , confidence interval , pathology , immunology , tuberculosis , sputum
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.