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Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country

Sandra Pedrero, Eva Tabernero, Eunate Arana-Arri, Elena Urra, Maialen Larrea, Rafael Zalacain
ERJ Open Research 2019 5: 00110-2018; DOI: 10.1183/23120541.00110-2018
Sandra Pedrero
1Dept of Respiratory Medicine, Hospital Universitario Cruces, Barakaldo, Spain
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  • For correspondence: sandra.pedrerotejada@osakidetza.eus
Eva Tabernero
1Dept of Respiratory Medicine, Hospital Universitario Cruces, Barakaldo, Spain
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Eunate Arana-Arri
2Research Unit, Hospital Universitario Cruces, Barakaldo, Spain
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Elena Urra
3Dept of Microbiology, Hospital Universitario Cruces, Barakaldo, Spain
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Maialen Larrea
3Dept of Microbiology, Hospital Universitario Cruces, Barakaldo, Spain
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Rafael Zalacain
1Dept of Respiratory Medicine, Hospital Universitario Cruces, Barakaldo, Spain
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  • FIGURE 1
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    FIGURE 1

    Overall incidence rates per 100 000 population of lung disease due to nontuberculous mycobacteria between 1997 and 2016. IRR: incident rate ratio.

  • FIGURE 2
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    FIGURE 2

    Incidence rates of lung disease due to nontuberculous mycobacteria between 1997 and 2016 by species involved: Mycobacterium kansasii and Mycobacterium avium complex. IRR: incident rate ratio.

Tables

  • Figures
  • TABLE 1

    Characteristics of lung infections by nontuberculous mycobacteria (NTM), overall and in each decade

    Total1st decade#2nd decade¶p-value
    Patients with NTM lung disease327257 (78.6%)70 (21.4%)<0.001
    NTM species
     Mycobacterium kansasii274 (83.8%)236 (91.6%)38 (54.3%)<0.001
     Mycobacterium avium complex43 (13.1%)15 (5.8%)28 (40.0%)
     Others+10 (3.1%)6 (1.8%)4 (1.2%)
    Age years mean56.8±1854±18.661±16.90.010
    Male71.2%75.2%57.1%0.003

    #: 1997–2006; ¶: 2007–2016; +: Mycobacterium celatum, Mycobacterium abscessus and Mycobacterium xenopi.

    • TABLE 2

      Risk factors, clinical and radiological characteristics of lung infections by nontuberculous mycobacteria, overall and in each decade

      Total1st decade#2nd decade¶p-value
      Risk factors
       HIV12.2%13.2%8.6%0.200
       Smoking53.6%60.4%44.8%0.003
       History of lung disease56%53%60.6%0.201
       COPD30.1%34%23.8%0.113
       Oral corticosteroid use6.7%8.2%4.5%0.283
       Alcohol use18.3%20.2%15.4%0.285
       Liver disease10.1%9.5%11.1%0.468
       Cancer22.6%23.8%20.6%0.395
       Gastroesophageal reflux9.6%11.5%6.6%0.233
      Signs and symptoms
       Cough/expectoration73.2%75.3%70.3%0.308
       Fever40.4%42.5%37.3%0.323
       Asthenia38%36.1%40.7%0.354
       Weight loss24.1%23.8%24.6%0.484
       Haemoptysis25.7%25%26.7%0.484
      Radiological findings
       Cavitation37.9%41.9%32.8%0.165
       Bronchiectasis29.3%22.6%38.1%0.032
       Nodules28.4%20.2%39.1%0.010
       Tree-in-bud pattern25.7%15.7%39.3%0.001
      Lung involvement
       Unilateral45.7%49.4%40.9%0.547
       Upper lung lobes52.4%58.8%43.3%0.260
       Middle lung lobes15.2%11.8%20%0.260
       Lower lung lobes15.2%9.4%6.7%0.260
       Multifocal22.1%18.8%26.7%0.260

      #: 1997–2006; ¶: 2007–2016.

      • TABLE 3

        Disease course and mortality from lung infections by nontuberculous mycobacteria (NTM), overall and in each decade

        Disease course and mortalityTotal1st decade#2nd decade¶p-value
        Microbiological cure275 (84.1%)228 (88.7%)47 (70.1%)<0.0001
        Overall mortality32 (9.8%)22 (8.5%)10 (14.3%)0.153
        Deaths due to NTM lung disease6 (1.8%)2 (0.8%)4 (5.7%)0.057
        Deaths due to other causes26 (79.5%)20 (7.7%)6 (8.6%)0.339

        #: 1997–2006; ¶: 2007–2016.

        • TABLE 4

          Comparison between Mycobacterium kansasii and Mycobacterium avium complex

          TotalM. kansasiiM. avium complexp-value
          Patients with NTM lung disease31727443
          Age years
           Mean±sd58.5±17.854.9±17.963.0±17.30.010
           Median (IQR)61 (44–73)57 (42–69)68 (47–78)
          Male patients296 (70.8%)204 (75.0%)65 (60.2%)0.003
          Risk factors
           HIV12.3%11.3%18.6%0.136
           Smoking55.1%63.8%31.0%<0.0001
           History of lung disease55.8%53.9%61.0%0.276
           COPD32.0%34.2%26.2%0.226
           Oral corticosteroid use6.5%4.5%11.9%0.100
           Alcohol use18.7%21.9%9.8%0.065
           Liver disease10.7%9.3%14.6%0.252
           Cancer22.7%27.7%9.5%0.011
           Gastroesophageal reflux10.2%10.1%10.5%0.577
          Signs and symptoms
           Cough/expectoration73.6%70.9%80.5%0.166
           Fever42.3%39.6%48.8%0.209
           Asthenia37.6%34.4%45.0%0.168
           Weight loss25.0%22.8%30.0%0.253
           Haemoptysis26.7%30.2%17.9%0.105
          Radiology
           Cavitation38.2%48.1%12.5%<0.0001
           Bronchiectasis29.0%19.2%53.8%<0.0001
           Nodules26.6%22.2%37.5%0.053
           Tree-in-bud pattern25.0%20.6%35.9%0.052
          Lung involvement#49.7%42.7%67.5%0.003
          Localisation
           Upper lung lobes53.4%57.1%42.9%0044
           Middle lung lobes15.0%10.2%28.6%0.044
           Lower lung lobes8.3%7.1%11.4%0044
           Multifocal23.3%25.5%17.1%0.044
          Disease course and mortality
           Microbiological cure87.3%89.0%76.7%0.029
           Overall mortality9.8%9.1%14.0%0.229
           Deaths due to NTM lung disease1.9%1.5%4.7%0.189
           Deaths due to other causes7.9%7.7%9.3%0.448

          NTM: nontuberculous mycobacteria; IQR: interquartile range. #: all unilateral.

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          Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country
          Sandra Pedrero, Eva Tabernero, Eunate Arana-Arri, Elena Urra, Maialen Larrea, Rafael Zalacain
          ERJ Open Research Oct 2019, 5 (4) 00110-2018; DOI: 10.1183/23120541.00110-2018

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          Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country
          Sandra Pedrero, Eva Tabernero, Eunate Arana-Arri, Elena Urra, Maialen Larrea, Rafael Zalacain
          ERJ Open Research Oct 2019, 5 (4) 00110-2018; DOI: 10.1183/23120541.00110-2018
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