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Clinical Significance of Mycobacterium kansasii Isolates from Respiratory Specimens.

Moon SM, Park HY, Jeon K, Kim SY, Chung MJ, Huh HJ, Ki CS, Lee NY, Shin SJ, Koh WJ - PLoS ONE (2015)

Bottom Line: None of the patients with a single sputum isolate (n = 18) developed M. kansasii disease over a median follow-up period of 12.0 months (IQR, 4.0-26.5 months).In total, 52% of all patients with M. kansasii respiratory isolates exhibited clinically significant disease.Thus, since the clinical significance of a single M. kansasii respiratory isolate is not definite, strict adherence to recommended diagnostic criteria is advised.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

ABSTRACT
The clinical significance of Mycobacterium kansasii respiratory isolates is uncertain. The aims of this study were to determine the clinical relevance of M. kansasii isolates and to identify the clinical features and outcomes of M. kansasii lung disease. We reviewed the medical records of 104 patients from whom at least one respiratory M. kansasii isolate was obtained from January 2003 to July 2014 at Samsung Medical Center, South Korea. Of these 104 patients, 54 (52%) met the diagnostic criteria for nontuberculous mycobacterial lung disease; among them, 41 (76%) patients received antibiotic treatment for a median time of 15.0 months (interquartile range [IQR], 7.0-18.0 months). The remaining 13 (24%) without overt disease progression were observed for a median period of 24.0 months (IQR, 5.0-34.5 months). Patients with M. kansasii lung disease exhibited various radiographic findings of lung disease, including the fibrocavitary form (n = 24, 44%), the nodular bronchiectatic form (n = 17, 32%), and an unclassifiable form (n = 13, 24%). The fibrocavitary form was more common in patients who received treatment (n = 23, 56%), while the nodular bronchiectatic form was more common in patients with M. kansasii lung disease who did not receive treatment (n = 9, 70%). None of the patients with a single sputum isolate (n = 18) developed M. kansasii disease over a median follow-up period of 12.0 months (IQR, 4.0-26.5 months). In total, 52% of all patients with M. kansasii respiratory isolates exhibited clinically significant disease. Moreover, patients with M. kansasii lung disease displayed diverse radiographic findings in addition to the fibrocavitary form. The nodular bronchiectatic form was more common in patients with M. kansasii lung disease with an indolent clinical course. Thus, since the clinical significance of a single M. kansasii respiratory isolate is not definite, strict adherence to recommended diagnostic criteria is advised.

No MeSH data available.


Related in: MedlinePlus

Diverse patterns in images of M. kansasii lung disease.(A) A 64-year-old man with M. kansasii lung disease. A coronal thin-section (2.5-mm thickness) CT scan shows a thick-walled cavitary lesion (arrow) with consolidation in the left upper lobe. Severe pulmonary emphysema is also observed. (B) A 66-year-old woman with M. kansasii lung disease. A transaxial thin-section (2.5-mm thickness) CT scan obtained at the basal trunk level shows bronchiectasis (arrows) and multiple branching centrilobular nodules, the so-called tree-in-bud pattern (arrowheads), in both lungs. (C) A-77-year-old man with M. kansasii lung disease. A transaxial (5-mm thickness) CT scan obtained at the level of the left main bronchus shows two nodules in the left lung (arrows). Lung biopsy revealed chronic granuloma; M. kansasii was isolated from the bronchial washing fluid.
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pone.0139621.g001: Diverse patterns in images of M. kansasii lung disease.(A) A 64-year-old man with M. kansasii lung disease. A coronal thin-section (2.5-mm thickness) CT scan shows a thick-walled cavitary lesion (arrow) with consolidation in the left upper lobe. Severe pulmonary emphysema is also observed. (B) A 66-year-old woman with M. kansasii lung disease. A transaxial thin-section (2.5-mm thickness) CT scan obtained at the basal trunk level shows bronchiectasis (arrows) and multiple branching centrilobular nodules, the so-called tree-in-bud pattern (arrowheads), in both lungs. (C) A-77-year-old man with M. kansasii lung disease. A transaxial (5-mm thickness) CT scan obtained at the level of the left main bronchus shows two nodules in the left lung (arrows). Lung biopsy revealed chronic granuloma; M. kansasii was isolated from the bronchial washing fluid.

Mentions: Among 54 patients who met the ATS/IDSA diagnostic criteria for NTM lung disease, 41 (76%) received antibiotic treatment and the median duration from diagnosis to initiation of treatment was 1.7 months (0.3–3.8 months). The remaining13 (24%) patients with mild symptoms underwent regular follow-up without antibiotic treatment for a median time of 26.5 months (IQR, 8.8–35.3 months) and a median of 8.0 (IQR 3.0–11.5) sputum cultures were obtained during follow-up. Based on the chest radiography and HRCT findings in all 54 patients, 24 (44%) patients manifested the fibrocavitary form, 17 (32%) had the nodular bronchiectatic form, and 13 (24%) exhibited an unclassifiable form of M. kansasii lung disease. The diverse radiographic findings are shown in Fig 1.


Clinical Significance of Mycobacterium kansasii Isolates from Respiratory Specimens.

Moon SM, Park HY, Jeon K, Kim SY, Chung MJ, Huh HJ, Ki CS, Lee NY, Shin SJ, Koh WJ - PLoS ONE (2015)

Diverse patterns in images of M. kansasii lung disease.(A) A 64-year-old man with M. kansasii lung disease. A coronal thin-section (2.5-mm thickness) CT scan shows a thick-walled cavitary lesion (arrow) with consolidation in the left upper lobe. Severe pulmonary emphysema is also observed. (B) A 66-year-old woman with M. kansasii lung disease. A transaxial thin-section (2.5-mm thickness) CT scan obtained at the basal trunk level shows bronchiectasis (arrows) and multiple branching centrilobular nodules, the so-called tree-in-bud pattern (arrowheads), in both lungs. (C) A-77-year-old man with M. kansasii lung disease. A transaxial (5-mm thickness) CT scan obtained at the level of the left main bronchus shows two nodules in the left lung (arrows). Lung biopsy revealed chronic granuloma; M. kansasii was isolated from the bronchial washing fluid.
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4592008&req=5

pone.0139621.g001: Diverse patterns in images of M. kansasii lung disease.(A) A 64-year-old man with M. kansasii lung disease. A coronal thin-section (2.5-mm thickness) CT scan shows a thick-walled cavitary lesion (arrow) with consolidation in the left upper lobe. Severe pulmonary emphysema is also observed. (B) A 66-year-old woman with M. kansasii lung disease. A transaxial thin-section (2.5-mm thickness) CT scan obtained at the basal trunk level shows bronchiectasis (arrows) and multiple branching centrilobular nodules, the so-called tree-in-bud pattern (arrowheads), in both lungs. (C) A-77-year-old man with M. kansasii lung disease. A transaxial (5-mm thickness) CT scan obtained at the level of the left main bronchus shows two nodules in the left lung (arrows). Lung biopsy revealed chronic granuloma; M. kansasii was isolated from the bronchial washing fluid.
Mentions: Among 54 patients who met the ATS/IDSA diagnostic criteria for NTM lung disease, 41 (76%) received antibiotic treatment and the median duration from diagnosis to initiation of treatment was 1.7 months (0.3–3.8 months). The remaining13 (24%) patients with mild symptoms underwent regular follow-up without antibiotic treatment for a median time of 26.5 months (IQR, 8.8–35.3 months) and a median of 8.0 (IQR 3.0–11.5) sputum cultures were obtained during follow-up. Based on the chest radiography and HRCT findings in all 54 patients, 24 (44%) patients manifested the fibrocavitary form, 17 (32%) had the nodular bronchiectatic form, and 13 (24%) exhibited an unclassifiable form of M. kansasii lung disease. The diverse radiographic findings are shown in Fig 1.

Bottom Line: None of the patients with a single sputum isolate (n = 18) developed M. kansasii disease over a median follow-up period of 12.0 months (IQR, 4.0-26.5 months).In total, 52% of all patients with M. kansasii respiratory isolates exhibited clinically significant disease.Thus, since the clinical significance of a single M. kansasii respiratory isolate is not definite, strict adherence to recommended diagnostic criteria is advised.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

ABSTRACT
The clinical significance of Mycobacterium kansasii respiratory isolates is uncertain. The aims of this study were to determine the clinical relevance of M. kansasii isolates and to identify the clinical features and outcomes of M. kansasii lung disease. We reviewed the medical records of 104 patients from whom at least one respiratory M. kansasii isolate was obtained from January 2003 to July 2014 at Samsung Medical Center, South Korea. Of these 104 patients, 54 (52%) met the diagnostic criteria for nontuberculous mycobacterial lung disease; among them, 41 (76%) patients received antibiotic treatment for a median time of 15.0 months (interquartile range [IQR], 7.0-18.0 months). The remaining 13 (24%) without overt disease progression were observed for a median period of 24.0 months (IQR, 5.0-34.5 months). Patients with M. kansasii lung disease exhibited various radiographic findings of lung disease, including the fibrocavitary form (n = 24, 44%), the nodular bronchiectatic form (n = 17, 32%), and an unclassifiable form (n = 13, 24%). The fibrocavitary form was more common in patients who received treatment (n = 23, 56%), while the nodular bronchiectatic form was more common in patients with M. kansasii lung disease who did not receive treatment (n = 9, 70%). None of the patients with a single sputum isolate (n = 18) developed M. kansasii disease over a median follow-up period of 12.0 months (IQR, 4.0-26.5 months). In total, 52% of all patients with M. kansasii respiratory isolates exhibited clinically significant disease. Moreover, patients with M. kansasii lung disease displayed diverse radiographic findings in addition to the fibrocavitary form. The nodular bronchiectatic form was more common in patients with M. kansasii lung disease with an indolent clinical course. Thus, since the clinical significance of a single M. kansasii respiratory isolate is not definite, strict adherence to recommended diagnostic criteria is advised.

No MeSH data available.


Related in: MedlinePlus