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Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease

BACKGROUND: Epidemiologic and clinical studies of Mycobacterium avium complex (MAC) pulmonary disease typically use strict ATS/IDSA definitions designed for decisions about treatment. Studies based on these criteria may exclude a substantial number of patients with true disease. We reviewed patients...

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Autores principales: Plotinsky, Rachel N., Talbot, Elizabeth A., von Reyn, C. Fordham
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827036/
https://www.ncbi.nlm.nih.gov/pubmed/24265675
http://dx.doi.org/10.1371/journal.pone.0077385
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author Plotinsky, Rachel N.
Talbot, Elizabeth A.
von Reyn, C. Fordham
author_facet Plotinsky, Rachel N.
Talbot, Elizabeth A.
von Reyn, C. Fordham
author_sort Plotinsky, Rachel N.
collection PubMed
description BACKGROUND: Epidemiologic and clinical studies of Mycobacterium avium complex (MAC) pulmonary disease typically use strict ATS/IDSA definitions designed for decisions about treatment. Studies based on these criteria may exclude a substantial number of patients with true disease. We reviewed patients treated for MAC pulmonary disease at an academic medical center to propose revised definitions encompass the full spectrum of MAC pulmonary disease. METHODS: We conducted a retrospective review of patients with MAC pulmonary disease treated from 1993–2006 by pulmonary or infectious disease specialists to assess whether treated patients met current ATS/IDSA microbiologic criteria and dichotomous radiologic classification as nodular/bronchiectatic (NB) or fibrocavitary (FC) disease. We propose a revised set of definitions that include categories of both probable and definite disease to include all treated patients. We further classify patients into dichotomous clinical categories as: “primary MAC” (without antecedent lung disease) or “secondary MAC” (smoking history or antecedent lung disease). RESULTS: Among 72 treated patients, 74% were female. Median age at diagnosis was 64 years; 41(57%) met ATS/IDSA criteria and 31 (43%) did not, most often for lack of multiple positive cultures. Dichotomous radiologic criteria were met by 48 (67%) patients (36 NB, 12 FC); the remaining 24 (33%) had both NB and FC findings or other abnormalities. Nineteen (26%) were classified as primary and 53 (74%) as secondary MAC (21 COPD, 4 bronchiectasis, 44 smoking history). CONCLUSIONS: We propose revised definitions for epidemiologic and clinical studies of MAC pulmonary disease that describe the full spectrum of disease.
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spelling pubmed-38270362013-11-21 Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease Plotinsky, Rachel N. Talbot, Elizabeth A. von Reyn, C. Fordham PLoS One Research Article BACKGROUND: Epidemiologic and clinical studies of Mycobacterium avium complex (MAC) pulmonary disease typically use strict ATS/IDSA definitions designed for decisions about treatment. Studies based on these criteria may exclude a substantial number of patients with true disease. We reviewed patients treated for MAC pulmonary disease at an academic medical center to propose revised definitions encompass the full spectrum of MAC pulmonary disease. METHODS: We conducted a retrospective review of patients with MAC pulmonary disease treated from 1993–2006 by pulmonary or infectious disease specialists to assess whether treated patients met current ATS/IDSA microbiologic criteria and dichotomous radiologic classification as nodular/bronchiectatic (NB) or fibrocavitary (FC) disease. We propose a revised set of definitions that include categories of both probable and definite disease to include all treated patients. We further classify patients into dichotomous clinical categories as: “primary MAC” (without antecedent lung disease) or “secondary MAC” (smoking history or antecedent lung disease). RESULTS: Among 72 treated patients, 74% were female. Median age at diagnosis was 64 years; 41(57%) met ATS/IDSA criteria and 31 (43%) did not, most often for lack of multiple positive cultures. Dichotomous radiologic criteria were met by 48 (67%) patients (36 NB, 12 FC); the remaining 24 (33%) had both NB and FC findings or other abnormalities. Nineteen (26%) were classified as primary and 53 (74%) as secondary MAC (21 COPD, 4 bronchiectasis, 44 smoking history). CONCLUSIONS: We propose revised definitions for epidemiologic and clinical studies of MAC pulmonary disease that describe the full spectrum of disease. Public Library of Science 2013-11-12 /pmc/articles/PMC3827036/ /pubmed/24265675 http://dx.doi.org/10.1371/journal.pone.0077385 Text en © 2013 Plotinsky et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Plotinsky, Rachel N.
Talbot, Elizabeth A.
von Reyn, C. Fordham
Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease
title Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease
title_full Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease
title_fullStr Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease
title_full_unstemmed Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease
title_short Proposed Definitions for Epidemiologic and Clinical Studies of Mycobacterium avium Complex Pulmonary Disease
title_sort proposed definitions for epidemiologic and clinical studies of mycobacterium avium complex pulmonary disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827036/
https://www.ncbi.nlm.nih.gov/pubmed/24265675
http://dx.doi.org/10.1371/journal.pone.0077385
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