Bronchiectasis and Nontuberculous Mycobacterial Disease
Section snippets
Pathophysiology: chicken and egg
Is NTM pulmonary disease a consequence or the cause (or both) of bronchiectasis? There are lines of evidence that support both contentions. First, it is clear that patients with severe generalized bronchiectasis, for whatever reason, are predisposed to acquiring NTM infection and in some instances progressive NTM disease. The best-described bronchiectasis-associated disease that is recognized as a predisposition for NTM infection is cystic fibrosis (CF). Olivier and colleagues17, 18 reported
Pathophysiology: NTM acquisition
The source of NTM respiratory pathogens is still assumed to be the environment, with increasing concern that biofilms that form in municipal water sources may be a significant source for NTM. Feazel and colleagues33 recently analyzed rRNA gene sequences from 45 showerhead biofilm sites around the United States. Sequences indicating M avium were identified in 20% of showerhead swabs. Using a quantitative polymerase chain reaction with M avium–specific primers, M avium DNA was detected in 20
Diagnosis: NTM lung disease in bronchiectasis patients
The diagnosis of NTM lung disease is dependent on 3 components: patient symptoms, radiographic findings, and microbiological results. In the setting of bronchiectasis, symptom evaluation is complicated because of the shared symptoms of bronchiectasis and NTM lung disease, including cough, sputum production, fatigue, and weight loss. A change or progression of symptoms may presage the diagnosis of NTM lung disease. Similarly, the radiographic abnormalities of bronchiectasis may mask or confuse
Therapy for NTM lung disease
It has been approximately 25 years since the newer macrolides, clarithromycin and the closely related azalide azithromycin, were recognized as the key element in successful treatment regimens for multiple NTM species, especially MAC. The limitations of macrolide-containing regimens for NTM pathogens are now abundantly clear, and it is equally clear that new, more potent medications are needed to improve therapy for NTM disease.
An especially frustrating problem in the management of patients with
Summary
The challenges for the clinician managing patients with NTM lung disease with bronchiectasis were summarized eloquently in a recent editorial.
Thus, the decision is made by the clinician, who may, in view of sometimes rather uncomfortable effects the drugs can have, be wise enough to keep under observation even some of those patients who fulfill consensus criteria for mycobacterial disease. Optimal conservative treatment of underlying disease should not be underestimated, either in this or other
References (59)
Forrest Gump
(1994)Nontuberculous mycobacteria and associated diseases
Am Rev Respir Dis
(1979)- et al.
Infection with Mycobacterium avium complex in patients without predisposing conditions
N Engl J Med
(1989) Pulmonary mycobacterial infections due to Mycobacterium intreacellulare-avium complex (clinical features and course in 100 consecutive cases)
Chest
(1979)- et al.
Diagnostic criteria for pulmonary disease caused by Mycobacterium kansasii and Mycobacterium intracellulare
Am Rev Respir Dis
(1982) - et al.
Clinical isolates of Mycobacterium simiae in San Antonio, Texas. An 11-yr review
Am J Respir Crit Care Med
(1995) - et al.
Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients
Am Rev Respir Dis
(1993) - et al.
Thrice-weekly clarithromycin-containing regimen for treatment of Mycobacterium kansasii lung disease: results of a preliminary study
Clin Infect Dis
(2003) - et al.
High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients
Radiol Med
(2010) - et al.
Bronchiectasis: assessment by thin-section CT
Radiology
(1986)
Value of medium-thickness CT in the diagnosis of bronchiectasis
AJR Am J Roentgenol
Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort
Chest
An investigation into causative factors in patients with bronchiectasis
Am J Respir Crit Care Med
Prevalence, age distribution and aetiology of bronchiectasis: a retrospective study on 144 symptomatic patients
Monaldi Arch Chest Dis
Non-tuberculous mycobacteria in patients with bronchiectasis
Thorax
Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics
Eur Respir J
Nontuberculous mycobacteria. II: nested-cohort study of impact on cystic fibrosis lung disease
Am J Respir Crit Care Med
Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis
Am J Respir Crit Care Med
Emergence of nontuberculous mycobacteria as pathogens in cystic fibrosis
Am J Respir Crit Care Med
Primary ciliary dyskinesia: diagnostic and phenotypic features
Am J Respir Crit Care Med
An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases
Am J Respir Crit Care Med
Pathological analysis of the cavitary wall in Mycobacterium avium intracellulare complex pulmonary infection
Intern Med
Pathological findings of bronchiectases caused by Mycobacterium avium intracellulare complex
Respir Med
Computed tomography findings of pulmonary infections caused by Mycobacterium avium complex in patient without predisposing conditions
Am Rev Respir Dis
Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome
Am J Respir Crit Care Med
Prospective analysis of cystic fibrosis transmembrane regulator mutations in adults with bronchiectasis or pulmonary nontuberculous mycobacterial infection
Chest
Alpha-1-antitrypsin (AAT) anomalies are associated with lung disease due to rapidly growing mycobacteria2 and AAT inhibits Mycobacterium abscessus infection of macrophages
Scand J Infect Dis
Nontuberculous mycobacterial infection: CT scan findings, genotype, and treatment responsiveness
Chest
Pulmonary Mycobacterium avium complex infection associated with the IVS8-T5 allele of the CFTR gene
Int J Tuberc Lung Dis
Cited by (52)
Clinical significance and safety of combined treatment with chemotherapy and pulmonary rehabilitation regarding health-related quality of life and physical function in nontuberculous mycobacterial pulmonary disease
2022, Respiratory InvestigationCitation Excerpt :Therefore, the importance of incorporating patient-reported outcome data, including health-related quality of life (HRQoL) assessment, into the evaluation of treatment endpoints has been emphasized [2,3]. Additionally, NTM-PD and bronchiectasis are closely related pathophysiologically [4]. Many patients with NTM-PD have bronchial mucus plugging [5], and symptoms of chronic cough with excessive sputum production (CCS) are a common clinical problem.
Mycobacterium abscessus Infected Neutrophils as an In Vitro Model for Bronchiectasis. Neutrophils Prevent Mycobacterial Aggregation
2022, Archivos de BronconeumologiaMycobacterium avium complex infected cells promote growth of the pathogen Pseudomonas aeruginosa
2022, Microbial PathogenesisCitation Excerpt :The more common respiratory NTM in bronchiectasis patients are M. avium complex (MAC) and M. abscessus. The radiographic forms of nontuberculous mycobacterial pulmonary disease are the fibrocavitary, similar to tuberculosis, or that characterized by nodules and bronchiectasis [9]. The two more important MAC species are M. avium and M. intracellulare.
Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease
2021, Journal of Clinical Tuberculosis and Other Mycobacterial DiseasesCitation Excerpt :Pulmonary disease is the most common manifestation of NTM infections [48], but NTM can also cause localized infection of the skin, bones and soft tissues; disseminated infections in patients with severely compromised immune systems can also occur. The current ATS/IDSA guidelines review these alternate manifestations but do not specifically address the diagnosis and treatment of extra-pulmonary NTM [3,44]. Common NTM infection syndromes are summarized in Table 1.
Chronic Lung Disease in Primary Antibody Deficiency: Diagnosis and Management
2020, Immunology and Allergy Clinics of North AmericaHost immune response against environmental nontuberculous mycobacteria and the risk populations of nontuberculous mycobacterial lung disease
2020, Journal of the Formosan Medical AssociationCitation Excerpt :Based on data from Taiwan National Health Insurance Research Database, bronchiectasis incidence is approximately 130 per 100,000 patients.45 Bronchiectasis might be secondary to NTM but their relationship are like chicken and egg.46 Regardless of the cause of bronchiectasis, its sequelae are poor airway clearance and decreased local immunity that promotes NTM growth.
The authors have no financial conflicts of interest to disclose.
D.E.G. is supported in part by the W.A. and E.B. Moncrief Distinguished Professorship.