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Nontuberculous mycobacterial pulmonary disease diagnosed by two methods: a prospective cohort study

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Authors
Kim, Hyung-Jun; Lee, Jong Hyuk; Yoon, Soon Ho; Kim, Sung A; Kim, Myoung Sil; Choi, Sun Mi; Lee, Jinwoo; Lee, Chang-Hoon; Han, Sung Koo; Yim, Jae-Joon
Issue Date
2019-05-24
Publisher
BioMed Central
Citation
BMC Infectious Diseases. 19(1):468
Keywords
Clinical medicineCohort studiesDiagnosisNontuberculous mycobacteriaProgression
Abstract
Background
Microbiological criteria for diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD) include positive culture results from at least two separately expectorated sputum specimens or one bronchial washing or lavage. However, the clinical similarities and differences between patients diagnosed by these two methods remain unclear. We compared clinical features and prognoses of patients with NTM-PD diagnosed from both specimen types.

Methods
We analysed data from patients who participated in the Seoul National University Hospital NTM-PD cohort (ClinicalTrials.gov identifier: NCT01616745). Baseline demographics, symptoms, radiographic findings, disease progression, and treatment responses were summarized and compared between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimens.

Results
Three hundred forty-seven patients were included in the analyses. Of these, 279 (80.4%) were diagnosed from two separately expectorated sputum specimens, and 68 (19.6%) were diagnosed from bronchoscopic specimens. Patients diagnosed from sputum specimens had more frequent and severe cough, sputum, postnasal drip, and high St. George’s Respiratory Questionnaire scores. However, the extent and severity of the radiographic lesions, disease progression, and treatment responses were similar for both groups. Further analysis based on the following three groups (sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy groups) suggested that the scanty sputum/bronchoscopy group appeared to have the worst prognosis in terms of both time to progression and time to culture conversion.

Conclusions
Although some symptoms and quality of life were worse in patients with NTM-PD diagnosed from sputum specimens, their prognoses were similar to those of patients diagnosed by bronchoscopic specimen. We recommend bronchoscopic sampling for patients in whom NTM-PD is suspected clinically or radiographically, especially those who have no or scanty sputum.
ISSN
1471-2334
Language
English
URI
http://hdl.handle.net/10371/156020
DOI
https://doi.org/10.1186/s12879-019-4078-0
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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