1. NTM with bronchiectasis (%) NTM without bronchiectasis (%)
Non-tuberculous mycobacteria and non cystic fibrosis bronchiectasis: a close relationship
Michael D. Schweitzer1,2, Kira Balestrini1,2, Andrea M. Guerrero1,2, Landy Luna Diaz1,2, Swathi Kesiraju1,2, Michael Campos1,2, Dean Schraufnagel1,2, Mehdi Mirsaeidi1,2.
1Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.
2Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA.
Prior studies indicate a frequency of 37% non-tuberculous mycobacteria (NTM) in bronchiectasis subjects.
Significant relationship between nodular bronchiectatic changes in chest images and the isolation of mycobacteria in sputum or bronchial alveolar lavage (BAL).
Mycobacterium avium complex has been identified as the most common isolate in patients with bronchiectasis.
Studies have also suggested an elderly female preponderance in NTM subjects with bronchiectasis.
Background
Results
Table 1. Characteristics of NTM-Bronchiectasis vs. NTM- without bronchiectasis
Chart 1. Percentage of Isolate NTM species in bronchiectasis and non-bronchiectasis group.
Variable
NTM with bronchiectasis (%)
NTM without bronchiectasis (%)
p-value
Age >65 years 47
(72.3) 77
(52.7)
0.08
Female
47 (72.3)
72 (49.3)
0.02
Caucasian
44 (71)
88 (61.5)
0.195
African
American 5
(8.1) 30
(21)
0.026a
Current smoker 7
(17.5) 34
(31.5)
0.091
Ex smoker
22 (59.5)
68 (67.3)
0.39
CHF
6 (9.2)
13 (8.9)
0.939
Liver Disease 1
(1.5) 9
(6.2)
0.18a DM
2 (3.1)
11 (7.6)
0.21
COPD
26 (42.6)
41 (28.9)
0.56
HIV
0 (0)
14 (9.6)
0.007a
Fever
5 (8.1)
22 (15.7)
0.141
Night sweats 13 20
(14.4)
0.245
New onset
cough 61
(96.8) 89
(64.5)
<0.001
Hemoptysis
20 (32.8)
33 (23.6)
0.173
Sputum production
54 (85.7)
76 (55.9)
0.000
Methods
Retrospective cohort study.
University of Illinois Medical Center and the Miami Veterans Affairs Healthcare System between 2010 and 2015.
Statistical analysis:
Categorical variables were described as counts and percentages and were tested by the Chi-square test, or, if applicable, Fischer’s exact test.
Univariate analysis was used to compare differences in demographic and clinical variables between NTM infected subjects with and without bronchiectasis.
Logistic regression to evaluate factors associated with bronchiectasis in NTM subjects.
Data analyses were executed using IBM SPSS Statistics for OS, version 22.
Two-tailed p-values were used and those <0.05 were considered to be statistically significant.
Table 2. Dual NTM-bronchiectasis subject characteristics on multivariate analysis.
Conclusions
Variable
p-value
Odds ratio
CI lower
(95%)
CI upper
Age >65 years
0.14
1.73
0.83
3.62
Male
<0.01
0.24
0.11
0.52
African American
0.72
0.82
0.26
2.50
COPD
0.01
2.53
1.21
5.29
MAC
0.70
1.87
0.95
3.65
M. kansasii
0.33
0.55
0.17
1.84
Dual bronchiectasis and NTM infection is common.
MAC and Mycobacterium abscessus appear to play a significant role in pulmonary NTM infections in those patients with bronchiectasis.
Elderly females are at increased risk of presenting both bronchiectasis and NTM infection.
We strongly suggest that initial assessment in patients with bronchiectasis consider sputum culture and if possible bronchoscopy, in cases in which imaging suggests NTM disease.
Objectives
Reaffirm previous findings regarding gender, age and MAC isolation in NTM-bronchiectasis subjects.
Identify the involvement of other mycobacterial species and associated illnesses in the relationship of the dual NTM- bronchiectasis disease.