Outcome of patients with and poor prognostic factors for Mycobacterium kansasii-pulmonary disease
Journal
Respiratory Medicine
Journal Volume
151
Pages
19-26
Date Issued
2019
Author(s)
Abstract
Background: Aggressive therapy for Mycobacterium kansasii-pulmonary disease (MK-PD) is recommended because of the virulence of MK. However, some clinicians may be concerned regarding the lengthy course and numerous adverse effects. This study evaluated the natural course of MK-PD and investigated its prognostic factors. Methods: Radiographic outcome, prognostic factors, and mortality within 1 year for MK-PD were obtained from patients in 6 hospitals in Taiwan from 2010 to 2014 (derivation cohort) and validated using patients in 2015 and 2016 (validation cohort). Results: Of the 109 patients with MK-PD in the derivation cohort, radiographic progression occurred in 70 (64%), with a 1-year mortality rate of 43% and median survival of 71 days, whereas none of the 39 cases without radiographic progression died. All patients with acid-fast smear (AFS) grade ? 3 experienced radiographic progression. For the others, the independent risk factors of radiographic progression were fibroCavitary pattern, Leucocyte count >9000/μL, Old age (age >65 years), pUre MK in sputum (no other mycobacteria), and no Diabetes mellitus (the CLOUD factors). By applying these criteria to the validation cohort (n = 112), 3 (9%) of the 33 patients with MK-PD who initially had AFS grade < 3 and < 3 CLOUD risk factors experienced radiographic progression, and none of the 3 died of MK-PD. Conclusions: Because of the high risk of radiographic progression and subsequent fatal outcome, immediate anti-MK treatment is recommended. For patients with MK-PD who have sputum AFS grade <3 and < 3 CLOUD risk factors, regular follow-up may be an alternative. ? 2019 The Author(s)
SDGs
Other Subjects
acid fast smear; age; aged; Article; atypical mycobacteriosis; clinical article; cohort analysis; female; human; leukocyte count; lung infection; male; median survival time; mortality rate; Mycobacterium kansasii; nonhuman; outcome assessment; priority journal; prognostic assessment; retrospective study; risk factor; smear; sputum analysis; Taiwan; thorax radiography; atypical mycobacteriosis; body mass; diagnostic imaging; disease exacerbation; epidemiology; leukocytosis; lung disease; microbiology; mortality; prognosis; radiography; sputum; Age Factors; Aged; Body Mass Index; Cohort Studies; Disease Progression; Female; Humans; Leukocytosis; Lung Diseases; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Prognosis; Radiography; Retrospective Studies; Risk Factors; Sputum; Taiwan
Publisher
W.B. Saunders Ltd
Type
journal article