ML has nothing to disclose. 2004;54(Pt 4):1277–85. Thus, the impact of MAC lung disease on mortality at a population level is more appropriately reflected in studies using matched control groups. Am J Respir Crit Care Med. Adjemian and colleagues found that US patients aged over 65 with NTM-PD within a nationally-representative sample were 40% more likely to die during the study period (1997–2007) than patients without NTM-PD [26]. The aim of this study was to investigate the natural course of untreated stable MAC-LD, with a focus on factors associated with clinical deterioration, spontaneous sputum conversion and prognosis. We systematically reviewed the literature up to 1st August 2017 using PubMed® and ProQuest Dialog™ to search Medline® and Embase® databases, respectively. J Microbiol Immunol Infect. Emerg Infect Dis. MAC lung disease natural history and long-term outcomes are poorly documented, particularly at the population level [8]. identified an even greater mortality risk (HR 3.64, 95% CI 2.28–5.77) and a mortality after 39 months follow-up of 22.4% for NTM-PD patients versus 6.0% for control patients [27]. Effective treatment choices for these people are few, essentially limited to intensification or modification of the first-line regimen or surgical resection of infected lung tissue [7]. Black bars indicate fibrocavitary disease, grey bars indicate nodular/bronchiectatic disease. Overall 5-year mortality was 28.0%.  |  c Fibrocavitary disease and all-cause five-year mortality. Despite high heterogeneity, most studies in patients with MAC pulmonary disease document a five-year all-cause mortality exceeding 25%, indicating poor prognosis. Part of In people with ... Read More. The authors suggested that this may be due to inconsistency among treatment protocols and in the reporting of key patient and study characteristics [9], preventing identification of clear factors related to treatment success. 2010;181(5):514–21. Poor adherence to management guidelines in nontuberculous mycobacterial pulmonary diseases. NIH Kyoto, Japan. Fortunately my MAC is localized in the one lobe or this would be a futile effort. ten) document a five-year mortality rate greater than 25% [12, 14, 15, 20, 21, 23,24,25], indicating a poor prognosis for patients with MAC lung disease and a need for more effective management of the condition. This selection was screened by title, abstract content and full text if needed. CAS  Two studies examined the relationship between nodular/bronchiectatic and fibrocavitary MAC lung disease and MAC-related mortality [13, 18]. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. The guidelines recommend staying on treatment for a minimum of 12 months after testing negative for MAC. Proposal to elevate the genetic variant MAC-A, included in the Mycobacterium avium complex, to species rank as Mycobacterium chimaera sp. The mortality in the data sets varied between 10 and 48%. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Furthermore, whereas all-cause mortality is an objective measure, the proportion of deaths attributed to MAC lung infection depends largely on how clinicians determine the cause of death. A previous systematic review of reported treatment outcomes in patients with MAC lung disease, based on a pooled analysis of 28 studies carried out between 1977 and 2004, found overall mortality to be 17% (95% confidence interval [CI] 15–18… Am Rev Respir Dis. Kaplan Meier … [Clinical study on development of nontuberculous mycobacterial lung disease]. MAC, Mycobacterium avium complex; NTM, nontuberculous mycobacterium. The decision to treat MAC infections depends on the patient’s health status and risk of disease progression. Fleshner and colleagues also documented pulmonary hypertension as a risk factor for mortality (aHR 2.1, 95% CI 0.9–5.1), although this was not significant following adjustment for fibrocavitary disease; importantly, individual NTM species were not significantly associated with mortality, suggesting similar risks for each NTM species identified in the study [28]. Heterogeneity in reported mortality rates was quantified in terms of the Q- and I2-statistics. 2016;60(11):6758–65. The proportion of all MAC-attributable deaths was reported by nine studies, and these data are shown in Fig. US Cystic Fibrosis Foundation and European cystic fibrosis society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis: executive summary. Henkle E, Novosad SA, Shafer S, Hedberg K, Siegel SA, Ku J, Varley C, Prevots DR, Marras TK, Winthrop KL. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014 software). Google Scholar. BMC Infect Dis 18, 206 (2018). Several factors appeared to be consistent across studies. This is in line with results from Fleshner and colleagues who identified fibrocavitary disease as a predictor of mortality in NTM-PD after controlling for possible confounders (adjusted hazard ratio [aHR] 3.3, 95% CI 1.3–8.3) [28]. Results: 2017;49(2):1601855. PubMed  Moon SM, Park HY, Kim SY, Jhun BW, Lee H, Jeon K, Kim DH, Huh HJ, Ki CS, Lee NY, et al. 2017;49(4):1602109. Ann Am Thorac Soc. Here, the mortality was 33.3% in cases versus 21.5% in controls. Hi - I was diagnosed with MAI (mycobacterium avium intracellulare) in 2000 and my culture was positive for aspergillus niger. Two studies examined patients with other NTM infections (with the data for the MAC subgroup considered for this analysis) [20, 21], and one investigated nodular/bronchiectatic MAC lung disease [18]. Following the exclusion criteria stated in the Methods section, 14 studies comprising 17 data sets with data from 9035 patients remained for analysis. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The airways can lose their ability to clear mucus and the mucus that accumulates within the airways can serve as a nutrient source and home for NTM, helping it to evade the immune system. Mycobacterium Avium Complex (my-koe-back-teer-ee-um ay-vee-um com-plecks) disease is among the most common bacterial infections in people with HIV. The analysis demonstrated that patients in Asian studies tended to have a lower five-year mortality (19, 95% CI 14–23%) compared with Europe (35, 95% CI 27–43%) and North America (33, 95% CI 32–35%). Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, et al. nov. Int J Syst Evol Microbiol. NTM are thought of as opportunistic pathogens, with disseminated NTM disease being seen in patients with systemic impaired immunity (e.g. Studies predominantly including patients with cavitary disease or greater comorbidity reported a higher risk of death. Yeager H, Raleigh JW. This demonstrated that patients with fibrocavitary disease have a substantially greater risk of death compared with nodular disease (Fig. Bamba Y, Moro H, Aoki N, Koizumi T, Ohshima Y, Watanabe S, Sakagami T, Koya T, Takada T, Kikuchi T. BMC Infect Dis. After adjustment for clinical, microbiological and radiological confounders, independent factors for 5-year mortality were a high Charlson comorbidity index in cases with definite MAC disease (hazard ratio [HR] 1.76) and untreated chronic MAC (HR 3.08), and presence of cavitary lesions in cases with definite MAC disease (HR 1.82) and treated MAC patients (HR 3.91). Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. MAC lung disease occurs rarely in immunocompetent hosts. PubMed Central  Predictors of 5-year mortality in pulmonary Mycobacterium avium-intracellulare complex disease. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Int J Tuberc Lung Dis. The I2 statistic was 96% and the Q-statistic was 365.1, indicating a high level of study heterogeneity. Predictors of mortality consistent across studies included male sex, presence of comorbidities and advanced patient age. Cite this article. Johnson MM, Odell JA. Clinical relevance of pulmonary non-tuberculous mycobacterial isolates in three reference centres in Belgium: a multicentre retrospective analysis. In a 1999 study, the median survival time was 9 months in patients treated with rifabutin, ethambutol, and clarithromycin. NTM-PD usually manifests radiologically with fibrocavitary or nodular/bronchiectatic forms [2]. PubMed Google Scholar. BMJ Open. However, all patients with disease considered bad enough to be recorded by investigators, and hence included in studies, are at some increased risk of death. Another recent systematic review sought to examine comorbidities, health-related quality of life and mortality associated with NTM disease in various patient populations [10]. Many are, however, refractory to first-line therapy and do not achieve sustained culture conversion [7]. Our sensitivity analysis identified a lower mortality rate in Asian studies, particularly those from Japan. 2014;11(1):1–8. Am J Respir Crit Care Med. Eur J Intern Med. The latter was found to be associated with increased MAC-related mortality rate in two studies [13, 18], and in one, all-cause mortality [13]. Privacy Duplicates, case reports, nonclinical and animal studies were excluded, as were conference abstracts, newspaper articles, notes, news, biography, conference reviews, errata and lectures. A flowchart depicting this selection process is shown in Fig. statement and Patients with cavitary lesions require immediate treatment for sputum culture conversion and to improve their chances of survival. The search strategy applied to each database is described in the Additional file 1. The present study has several limitations. The number of patients with MAC in the studies ranged from 45 to 5543. According to published recommendations, patients with nodular/bronchiectatic MAC disease should be offered a combination of macrolide (clarithromycin or azithromycin), rifampin or rifabutin, and ethambutol [2, 4]. [ 16] reported that desiccated M. avium lose viability at a constant rate (half-life, 2.3 days). PubMed  The analysis was performed using Review Manager (RevMan version 5.3. Fleshner M, Olivier KN, Shaw PA, Adjemian J, Strollo S, Claypool RJ, Folio L, Zelazny A, Holland SM, Prevots DR. Mortality among patients with pulmonary non-tuberculous mycobacteria disease. Clarithromycin vs ciprofloxacin as adjuncts to rifampicin and ethambutol in treating opportunist mycobacterial lung diseases and an assessment of Mycobacterium vaccae immunotherapy. HIV) [2, 3]. Thus, it is not possible to draw firm conclusions regarding longer-term mortality from this report. Studies with fewer than ten patients were excluded because of uncertainty about validity of the presented data and outcome in smaller studies. Pulmonary nontuberculous mycobacteria-associated deaths, Ontario, Canada, 2001-2013. PubMed  Objective: a Forest plot of five-year all-cause mortality rates in the identified data sets. Get the latest public health information from CDC: https://www.coronavirus.gov. A worse prognosis was noted with male sex, comorbidities (e.g. There are two main clinical presentations for NTM infection, which means that the symptoms and signs associated with this disorder are expressed in two specific ways. WH, RD and ML had access to and interpreted the data, contributed to the writing and review of the manuscript and approved the final version. This infection … This inevitably means that one must be careful to not over-interpret their findings. A high degree of heterogeneity was observed (I2 = 96%). Andréjak and colleagues noted a similar prognosis in Danish patients with confirmed NTM-PD (57% of whom had MAC isolation) compared with those with NTM isolation only (HR 1.15, 95% CI 0.90–1.51) [20]. English language studies were selected. Article  HIV) or heterogeneity of treatment regimens between studies as the selected studies did not report outcomes for different subgroups. Among these 17 data sets, nine were retrospective medical chart review studies [12,13,14,15,16,17,18,19], five were retrospective population registry analyses [20,21,22,23] and three were from prospective, randomised studies [24, 25]. Anyone know anything about this disease. Of 488 patients diagnosed with MAC … Pooling data from all 17 data sets using a random effects model, the overall estimate of five-year all-cause mortality was 27% (95% CI 21.3–33.0%). 2007;175(4):367–416. Individuals with no known lung disease can also be infected with these mycobacteria, in which case MAC infection … a The proportion of all deaths related to MAC lung disease in the identified data sets. Bronchiectasis is a chronic incurable lung disease problematic for the bronchial tubes (passages that carry air into the lungs).  |  Development and validation of a prognostic scoring model for Mycobacterium avium complex lung disease: an observational cohort study. The less severe form is known as nodular bronchiectasis, in which the airways of the lungs become damaged, and subsequently dilate and become scarred. Mortality data were extracted and analysed to determine a pooled estimate of all-cause mortality. It is important to note that, as many reported studies are frequently based on population-level data (for example, [21]), they can contain limited clinical information. This is a concern, as recent work from Korea reported a five-year mortality of 47.1% (95% CI 24.0–70.1) in patients with macrolide-resistant MAC [31]. 2002;6(7):628–34. One published study reviewed the long-term outlook of people with MAC infections … Again, variable follow-up times in the included studies (30 days to over 10 years) limited the understanding of long-term mortality. It is like tuberculosis but is not contagious. 2009;339:b2535. Clipboard, Search History, and several other advanced features are temporarily unavailable. Article  The studies we have identified cover a wide time period (1973–2017) and thus may be influenced by potential variability in NTM diagnosis and treatment over the 44 year period. Yeung MW, Khoo E, Brode SK, Jamieson FB, Kamiya H, Kwong JC, Macdonald L, Marras TK, Morimoto K, Sander B. Health-related quality of life, comorbidities and mortality in pulmonary nontuberculous mycobacterial infections: a systematic review. Asakura T, Hayakawa N, Hasegawa N, Namkoong H, Takeuchi K, Suzuki S, Ishii M, Bestuyaku T, Abe Y, Ouchi M. Long-term outcome of pulmonary resection for nontuberculous mycobacterial pulmonary disease. Multiplex cytokine analysis in Mycobacterium avium complex lung disease: relationship between CXCL10 and poor prognostic factors. Among 117 patients with microbiological outcomes, 54 were treated (treated MAC patients) and 24 were not treated and did not experience sputum culture conversion during follow-up (untreated chronic MAC patients); 39 patients were not treated and experienced sputum culture conversion. Zoumot Z, Boutou AK, Gill SS, van Zeller M, Hansell DM, Wells AU, Wilson R, Loebinger MR. Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis. 1 doctor agrees. Google Scholar. Factors that affect sputum conversion and treatment outcome in patients with Mycobacterium avium-intracellulare complex pulmonary disease. 2020 Oct 19;6(4):00317-2020. doi: 10.1183/23120541.00317-2020. A number of patient groups have been associated with increased risk of pulmonary MAC. Ronai Z, Csivincsik A, Dan A. Molecular identification of Mycobacterium avium subsp. Ann Am Thorac Soc. However, it is also seen frequently in otherwise healthy patients, with a predilection for older women who deliberately suppress the cough reflex (Lady Windermere syndrome) 1-3. 2017;17(1):436. Article  Respirology. In other words, a MAC … Am J Respir Crit Care Med. Further prospective studies using appropriately matched controls may contribute to a better understanding of long-term survival in MAC-related pulmonary disease. CAS  Google Scholar. MAC is considered to be the most common cause of NTM-PD [4]. In line with previous reports [9], we found there to be considerable heterogeneity between studies, with an I2 value of 96% and Q-statistic of 365.1. Thus, our analysis is influenced by the design of the selected studies. Google Scholar. 2016;21(6):1015–25. The usual length of treatment lasts for at least 15 to 18 months. Database searches were carried out in Medline® and Embase®, using PubMed® and ProQuest Dialog™ search tools, respectively, with a cut-off of 1st August 2017, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [11]. The following data were extracted from the selected publications: five-year all-cause mortality, proportion of MAC-attributable deaths, factors predicting all-cause mortality, all-cause mortality in patients with fibrocavitary or nodular/bronchiectatic disease, and MAC-related mortality in patients with fibrocavitary or nodular/bronchiectatic disease. 2014;33(3):347–58. 3c). Specifically, only two prospective studies (including three data sets) are included in our analysis [24, 25]. Please enable it to take advantage of the complete set of features! 2008;63(7):627–34. Although predictors of mortality varied between studies, some common features were observed. Respirology. The most common type of nontuberculous mycobacterial lung infection that causes pulmonary disease in the United States are due to the group of bacteria in the M. avium complex (MAC). We performed a sensitivity analysis using the geographic region in which the selected studies were conducted (Additional file 1: Table S1). Retrospective study of 164 patients diagnosed with pulmonary MAC disease between 1999 and 2005 and followed for 5 years. These studies indicate that NTM-PD increases mortality risk at a population level, independent of underlying comorbidities. I can live with a little … California Privacy Statement, BMC Infectious Diseases MAC lung disease is an infection caused a group of bacteria called Mycobacterium avium complex (MAC). Pulmonary disease caused by Mycobacterium avium-intracellulare in HIV-negative patients: five-year follow-up of patients receiving standardised treatment. MAC-related five-year all-cause mortality varied between 5% [25] and 42% [16]. Get the latest research from NIH: https://www.nih.gov/coronavirus. A retrospective chart review of patients from Oregon, USA with respiratory NTM isolates found that the median time to death was 3.6 (range 0–7.7) years for cases meeting ATS/IDSA diagnostic criteria [2] and 3.7 (range 0.0–8.6) years for those who did not (p = 0.63). Int J Tuberc Lung Dis. Google Scholar. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The studies identified in this systematic review show that, in general, patients with MAC lung disease are at a high risk of death following their diagnosis, with a pooled estimate of five-year all-cause mortality of 27%. The Q-statistic is based on the chi-squared test and assesses deviation between individual study effect and the pooled effect across studies. 0 … Analysis of five-year mortality in selected data sets. BTS; The Research Committee of the British Thoracic Society. Cookies policy. PubMed  Curr Opin Infect Dis. Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. [21] Although HIV-infected patients with DMAC infections … One study also analysed the relationship between radiologic types of MAC lung disease and all-cause five-year mortality [13]. *Three of the identified publications contained data sets for two cohorts of patients, and these are considered separately here. PubMed  In one study, MAC … Predictors of better outcome include surgical treatment [12] and nodular or bronchiectatic disease [15]. This may be driven, in part, by the relatively high proportion of nodular/bronchiectatic disease in Japanese studies [15], which most reports suggest has a better outcome. Int J Tuberc Lung Dis. Article  This publication was supported by an educational grant from Insmed Inc. BMC Infect Dis. The mortality rate was 9.2 per 100 patient-years. J Pathog. Springer Nature. MAC … This is much higher than the pooled estimate from our analysis indicating that macrolide resistance increases mortality risk, and should be specifically identified in future studies. 2015;53(5):1582–7. Flow chart describing the selection of studies and data sets included in the analysis.

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