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784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States

BACKGROUND: The epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the United States is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fol...

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Autores principales: Dousa, Khalid M, Ponce-Terashima, Rafael, Aartsen, Daniel Van, La Hoz, Alejandro De, Johnson, John L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254709/
http://dx.doi.org/10.1093/ofid/ofy210.791
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author Dousa, Khalid M
Ponce-Terashima, Rafael
Aartsen, Daniel Van
La Hoz, Alejandro De
Johnson, John L
author_facet Dousa, Khalid M
Ponce-Terashima, Rafael
Aartsen, Daniel Van
La Hoz, Alejandro De
Johnson, John L
author_sort Dousa, Khalid M
collection PubMed
description BACKGROUND: The epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the United States is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fold. Malignancy, immunosuppression, and tumor necrosis factor inhibitors are known risk factors for DMAC. We sought to describe the epidemiology of DMAC disease in HIV seronegative patients in the United States. METHODS: We performed a retrospective analysis of a commercial database (Explorys Inc., Cleveland, OH). This database contains an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to present. Explorys contains de-identified information from over 50 million patients, 360 hospitals, and over 317,000 providers. We identified a total of 571 persons diagnosed with DMAC, based on Systemized Nomenclature of Medicine-Clinical Terms. We excluded 80 HIV-infected and identified association of the infection with known risk factors. RESULTS: Of 570 patients, 491 HIV-uninfected patients with DMAC were studied. Underlying structural pulmonary diseases were COPD and bronchiectasis (51% and 47%, respectively). Two hundred ten patients had concomitant malignancy of which lung cancer was the most frequent (43%). Seventy-nine percent were receiving corticosteroids and 10 patients (2%) were on TNF inhibitors (2%). CONCLUSION: In this study, majority of patients with DMAC are HIV-uninfected. Larger studies should focus on identifying the prevalence and risk factors of DMAC in the post-AIDS era. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62547092018-11-28 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States Dousa, Khalid M Ponce-Terashima, Rafael Aartsen, Daniel Van La Hoz, Alejandro De Johnson, John L Open Forum Infect Dis Abstracts BACKGROUND: The epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the United States is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fold. Malignancy, immunosuppression, and tumor necrosis factor inhibitors are known risk factors for DMAC. We sought to describe the epidemiology of DMAC disease in HIV seronegative patients in the United States. METHODS: We performed a retrospective analysis of a commercial database (Explorys Inc., Cleveland, OH). This database contains an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to present. Explorys contains de-identified information from over 50 million patients, 360 hospitals, and over 317,000 providers. We identified a total of 571 persons diagnosed with DMAC, based on Systemized Nomenclature of Medicine-Clinical Terms. We excluded 80 HIV-infected and identified association of the infection with known risk factors. RESULTS: Of 570 patients, 491 HIV-uninfected patients with DMAC were studied. Underlying structural pulmonary diseases were COPD and bronchiectasis (51% and 47%, respectively). Two hundred ten patients had concomitant malignancy of which lung cancer was the most frequent (43%). Seventy-nine percent were receiving corticosteroids and 10 patients (2%) were on TNF inhibitors (2%). CONCLUSION: In this study, majority of patients with DMAC are HIV-uninfected. Larger studies should focus on identifying the prevalence and risk factors of DMAC in the post-AIDS era. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254709/ http://dx.doi.org/10.1093/ofid/ofy210.791 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Dousa, Khalid M
Ponce-Terashima, Rafael
Aartsen, Daniel Van
La Hoz, Alejandro De
Johnson, John L
784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
title 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
title_full 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
title_fullStr 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
title_full_unstemmed 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
title_short 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
title_sort 784. the changing epidemiology of disseminated mycobacterium avium complex in the united states
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254709/
http://dx.doi.org/10.1093/ofid/ofy210.791
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