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Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483267/ https://www.ncbi.nlm.nih.gov/pubmed/31022253 http://dx.doi.org/10.1371/journal.pone.0216034 |
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author | Kimizuka, Yoshifumi Hoshino, Yoshihiko Nishimura, Tomoyasu Asami, Takahiro Sakakibara, Yumi Morimoto, Kozo Maeda, Shinji Nakata, Noboru Abe, Takayuki Uno, Shunsuke Namkoong, Ho Fujiwara, Hiroshi Funatsu, Yohei Yagi, Kazuma Fujie, Toshihide Ishii, Makoto Inase, Naohiko Iwata, Satoshi Kurashima, Atsuyuki Betsuyaku, Tomoko Hasegawa, Naoki |
author_facet | Kimizuka, Yoshifumi Hoshino, Yoshihiko Nishimura, Tomoyasu Asami, Takahiro Sakakibara, Yumi Morimoto, Kozo Maeda, Shinji Nakata, Noboru Abe, Takayuki Uno, Shunsuke Namkoong, Ho Fujiwara, Hiroshi Funatsu, Yohei Yagi, Kazuma Fujie, Toshihide Ishii, Makoto Inase, Naohiko Iwata, Satoshi Kurashima, Atsuyuki Betsuyaku, Tomoko Hasegawa, Naoki |
author_sort | Kimizuka, Yoshifumi |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6483267 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-64832672019-05-09 Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease Kimizuka, Yoshifumi Hoshino, Yoshihiko Nishimura, Tomoyasu Asami, Takahiro Sakakibara, Yumi Morimoto, Kozo Maeda, Shinji Nakata, Noboru Abe, Takayuki Uno, Shunsuke Namkoong, Ho Fujiwara, Hiroshi Funatsu, Yohei Yagi, Kazuma Fujie, Toshihide Ishii, Makoto Inase, Naohiko Iwata, Satoshi Kurashima, Atsuyuki Betsuyaku, Tomoko Hasegawa, Naoki PLoS One Research Article 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. Public Library of Science 2019-04-25 /pmc/articles/PMC6483267/ /pubmed/31022253 http://dx.doi.org/10.1371/journal.pone.0216034 Text en © 2019 Kimizuka 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 (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kimizuka, Yoshifumi Hoshino, Yoshihiko Nishimura, Tomoyasu Asami, Takahiro Sakakibara, Yumi Morimoto, Kozo Maeda, Shinji Nakata, Noboru Abe, Takayuki Uno, Shunsuke Namkoong, Ho Fujiwara, Hiroshi Funatsu, Yohei Yagi, Kazuma Fujie, Toshihide Ishii, Makoto Inase, Naohiko Iwata, Satoshi Kurashima, Atsuyuki Betsuyaku, Tomoko Hasegawa, Naoki Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease |
title | Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease |
title_full | Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease |
title_fullStr | Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease |
title_full_unstemmed | Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease |
title_short | Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease |
title_sort | retrospective evaluation of natural course in mild cases of mycobacterium avium complex pulmonary disease |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483267/ https://www.ncbi.nlm.nih.gov/pubmed/31022253 http://dx.doi.org/10.1371/journal.pone.0216034 |
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