Chest
Original Research: Chest InfectionsLong-term Follow-up of Mycobacterium avium Complex Lung Disease in Patients Treated With Regimens Including Clofazimine and/or Rifampin
Section snippets
Patient Population
All patients treated at the Calgary Tuberculosis Clinic (Calgary, AB, Canada) from January 1, 1990 to December 31, 2009 for pulmonary nontuberculous mycobacterial infections were reviewed (Fig 1). Patients were included in the study if (1) they were 18 years of age or older; (2) they met ATS/IDSA diagnostic criteria for MAC lung disease including (a) pulmonary symptoms, (b) the presence of multifocal bronchiectasis and multiple small nodules on chest radiograph or high-resolution CT scan of the
Patient Population
One hundred and seven patients seen at the Calgary Tuberculosis Clinic between January 1990 and December 2009 met inclusion criteria. One hundred and fifty patients treated for MAC lung disease were assessed, and 43 patients were excluded (see Fig 1 for details). Follow-up data were collected until March 31, 2013. Patients were predominantly female (n = 84; 79%) with a mean age at treatment initiation of 67.0 ± 11.9 years (range, 38-88 years). A minority of patients (6%) were immunocompromised (
Discussion
Patients with MAC lung disease treated with macrolide-containing multidrug regimens had an excellent culture conversion rate (95%). Following completion of treatment, approximately one-half of patients (49%) experienced microbiologic relapse. In addition to microbiologic relapse, 38 of 107 (36%) also developed worsening clinical symptoms and/or radiologic progression that required re-treatment. There was a significantly higher culture conversion rate among patients treated with a
Conclusions
In summary, this is the first report of a large number of patients with MAC lung disease, most of whom were treated with clofazimine-containing regimens and were monitored for an extended period allowing for the determination of re-treatment rates. The vast majority of patients can achieve negative sputum culture results. Microbiologic relapses occur in half of patients and approximately one-third of patients require re-treatment. Microbiologic and treatment outcomes in patients treated with
Acknowledgments
Author contributions: J. J. is guarantor of the manuscript. J. J. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. J. P. D., R. L. C., D. A. F., and S. K. F. contributed substantially to the study design, data analysis and interpretation, and writing of the manuscript.
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.