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Evidence of mycobacterial disease in COPD patients with lung volume reduction surgery; the importance of histological assessment of specimens: a cohort study.

Char A, Hopkinson NS, Hansell DM, Nicholson AG, Shaw EC, Clark SJ, Sedgwick P, Wilson R, Jordan S, Loebinger MR - BMC Pulm Med (2014)

Bottom Line: Mycobacteria were only identified in those patients with granulomas that were necrotising.These patients had higher exacerbation rates, lower TLCO and FEV1.This may have implications for long-term management of these patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Royal Brompton and Harefield NHS Foundation Trust, London, UK. m.loebinger@rbht.nhs.uk.

ABSTRACT

Background: Patients with COPD are at risk of non-tuberculous mycobacterial infection (NTM). This study examined the histology of lung tissue from COPD patients following lung volume reduction with particular focus on evidence of mycobacterial infection.

Methods: Retrospective histological study of 142 consecutive lung volume reduction surgical specimens (126 separate patients) at Royal Brompton Hospital between 2000 - 2013, with prospectively collected preoperative data on exacerbation rate, lung function and body mass index.

Results: 92% of patients had at least one other histological diagnosis in addition to emphysema. 10% of specimens had histological evidence of mycobacterial infection, one with co-existent aspergilloma. Mycobacteria were only identified in those patients with granulomas that were necrotising. These patients had higher exacerbation rates, lower TLCO and FEV1.

Conclusion: A proportion of severe COPD patients will have evidence of mycobacterial infection despite lack of clinical and radiological suspicion. This may have implications for long-term management of these patients.

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Related in: MedlinePlus

Chest CT scan showing emphysema and nodule (arrow).
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Figure 2: Chest CT scan showing emphysema and nodule (arrow).

Mentions: Fourteen histological reports had evidence of mycobacterial infection, with one or more necrotising granulomas, and 8 of which showed acid-fast bacilli on Ziehl-Nielsen staining. As there was no clinical suspicion of mycobacterial infection at the time of the operation, a minority (4/14 samples) were sent for mycobacterial tissue culture; and 2 specimens subsequently grew Mycobacterium xenopi. Although there were no other tissue cultures, a further 8 patients had sputum samples cultured for mycobacteria with 1 of these samples culturing mycobacterium kansasii (Figure 1). In one case in which AFBs were present, an aspergilloma was also noted. Fungal stains on the remaining cases were negative. HRCT scans (median time from operation date 28 days (1–47)) were reviewed retrospectively in the patients with histopathological evidence of necrotising granulomas (13/14 scans available) to specifically look for nodules and CT features compatible with mycobacterial disease. Twelve out of these 13 scans had evidence of small nodules (3-15 mm) (Figure 2). Even with the knowledge of the histological findings, only three scans had features that were suggestive of a radiological diagnosis of non-tuberculous mycobacterial infection.


Evidence of mycobacterial disease in COPD patients with lung volume reduction surgery; the importance of histological assessment of specimens: a cohort study.

Char A, Hopkinson NS, Hansell DM, Nicholson AG, Shaw EC, Clark SJ, Sedgwick P, Wilson R, Jordan S, Loebinger MR - BMC Pulm Med (2014)

Chest CT scan showing emphysema and nodule (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4125594&req=5

Figure 2: Chest CT scan showing emphysema and nodule (arrow).
Mentions: Fourteen histological reports had evidence of mycobacterial infection, with one or more necrotising granulomas, and 8 of which showed acid-fast bacilli on Ziehl-Nielsen staining. As there was no clinical suspicion of mycobacterial infection at the time of the operation, a minority (4/14 samples) were sent for mycobacterial tissue culture; and 2 specimens subsequently grew Mycobacterium xenopi. Although there were no other tissue cultures, a further 8 patients had sputum samples cultured for mycobacteria with 1 of these samples culturing mycobacterium kansasii (Figure 1). In one case in which AFBs were present, an aspergilloma was also noted. Fungal stains on the remaining cases were negative. HRCT scans (median time from operation date 28 days (1–47)) were reviewed retrospectively in the patients with histopathological evidence of necrotising granulomas (13/14 scans available) to specifically look for nodules and CT features compatible with mycobacterial disease. Twelve out of these 13 scans had evidence of small nodules (3-15 mm) (Figure 2). Even with the knowledge of the histological findings, only three scans had features that were suggestive of a radiological diagnosis of non-tuberculous mycobacterial infection.

Bottom Line: Mycobacteria were only identified in those patients with granulomas that were necrotising.These patients had higher exacerbation rates, lower TLCO and FEV1.This may have implications for long-term management of these patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Royal Brompton and Harefield NHS Foundation Trust, London, UK. m.loebinger@rbht.nhs.uk.

ABSTRACT

Background: Patients with COPD are at risk of non-tuberculous mycobacterial infection (NTM). This study examined the histology of lung tissue from COPD patients following lung volume reduction with particular focus on evidence of mycobacterial infection.

Methods: Retrospective histological study of 142 consecutive lung volume reduction surgical specimens (126 separate patients) at Royal Brompton Hospital between 2000 - 2013, with prospectively collected preoperative data on exacerbation rate, lung function and body mass index.

Results: 92% of patients had at least one other histological diagnosis in addition to emphysema. 10% of specimens had histological evidence of mycobacterial infection, one with co-existent aspergilloma. Mycobacteria were only identified in those patients with granulomas that were necrotising. These patients had higher exacerbation rates, lower TLCO and FEV1.

Conclusion: A proportion of severe COPD patients will have evidence of mycobacterial infection despite lack of clinical and radiological suspicion. This may have implications for long-term management of these patients.

Show MeSH
Related in: MedlinePlus