Sanne Zweijpfenning1, Stephan Kops2, Cecile Magis-Escurra3, Martin J Boeree4, Jakko van Ingen5, Wouter Hoefsloot6. 1. Radboud University Medical Centre, University Centre of Chronic Diseases Dekkerswald, Department of Pulmonary Diseases, PO Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: sanne.zweijpfenning@radboudumc.nl. 2. Radboud University Medical Centre, University Centre of Chronic Diseases Dekkerswald, Department of Pulmonary Diseases, PO Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: Stephan.kops@radboudumc.nl. 3. Radboud University Medical Centre, University Centre of Chronic Diseases Dekkerswald, Department of Pulmonary Diseases, PO Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: Cecile.Magis-Escurra@radboudumc.nl. 4. Radboud University Medical Centre, University Centre of Chronic Diseases Dekkerswald, Department of Pulmonary Diseases, PO Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: Martin.Boeree@radboudumc.nl. 5. Radboud University Medical Centre, Department of Medical Microbiology, PO Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: Jakko.vanIngen@radboudumc.nl. 6. Radboud University Medical Centre, University Centre of Chronic Diseases Dekkerswald, Department of Pulmonary Diseases, PO Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: Wouter.Hoefsloot@radboudumc.nl.
Abstract
BACKGROUND: The incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased in the Netherlands. The fibro-cavitary disease manifestation predominates, as elsewhere in Europe. We studied treatment and outcome of this disease manifestation, as such data are scarce. METHODS: We conducted a retrospective study of all patients diagnosed with NTM-PD according to the American Thoracic Society statement between 2008 and 2013 in a reference clinic. RESULTS: Sixty-three patients were included. Thirty-two (51%) were females and mean age was 60.8 years. Most patients had underlying COPD (73%). M. avium complex pulmonary disease (MAC-PD) was most frequent (n = 38, 60.3%), followed by M. malmoense (n = 7) and M. kansasii (n = 6). Twenty-two patients had fibro-cavitary MAC-PD, 14 had nodular-bronchiectatic MAC-PD and 2 had other manifestations. Thirty-two (94%) patients treated for MAC-PD received a rifamycin-ethambutol-macrolide based regimen. Microbiological cure rates were lower for fibro-cavitary (52.4%) than for nodular bronchiectatic MAC-PD (100%; p = 0.03). Sixty-nine percent of treated patients experienced adverse events, most frequently gastrointestinal discomforts (71%), tinnitus (18%), hearing impairment (16%) and hepatotoxicity (18%). CONCLUSIONS: Fibro-cavitary NTM-PD remains predominant, but is now diagnosed more frequently in women. Fibro-cavitary disease is harder to cure than nodular-bronchiectatic disease. Adverse events are frequent and can necessitate cessation of treatment.
BACKGROUND: The incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased in the Netherlands. The fibro-cavitary disease manifestation predominates, as elsewhere in Europe. We studied treatment and outcome of this disease manifestation, as such data are scarce. METHODS: We conducted a retrospective study of all patients diagnosed with NTM-PD according to the American Thoracic Society statement between 2008 and 2013 in a reference clinic. RESULTS: Sixty-three patients were included. Thirty-two (51%) were females and mean age was 60.8 years. Most patients had underlying COPD (73%). M. avium complex pulmonary disease (MAC-PD) was most frequent (n = 38, 60.3%), followed by M. malmoense (n = 7) and M. kansasii (n = 6). Twenty-two patients had fibro-cavitary MAC-PD, 14 had nodular-bronchiectatic MAC-PD and 2 had other manifestations. Thirty-two (94%) patients treated for MAC-PD received a rifamycin-ethambutol-macrolide based regimen. Microbiological cure rates were lower for fibro-cavitary (52.4%) than for nodular bronchiectatic MAC-PD (100%; p = 0.03). Sixty-nine percent of treated patients experienced adverse events, most frequently gastrointestinal discomforts (71%), tinnitus (18%), hearing impairment (16%) and hepatotoxicity (18%). CONCLUSIONS: Fibro-cavitary NTM-PD remains predominant, but is now diagnosed more frequently in women. Fibro-cavitary disease is harder to cure than nodular-bronchiectatic disease. Adverse events are frequent and can necessitate cessation of treatment.
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Authors: Rabi Danho; Jodie A Schildkraut; Sanne M H Zweijpfenning; Elin M Svensson; Lian J Pennings; Saskia Kuipers; Heiman F L Wertheim; Martin J Boeree; Wouter Hoefsloot; Jakko van Ingen Journal: Chest Date: 2021-08-13 Impact factor: 9.410
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