Clinical, radiological and molecular features of Mycobacterium kansasii pulmonary disease. (June 2018)

• Record Type: Journal Article
• Authors: Bakuła, Zofia; Kościuch, Justyna; Safianowska, Aleksandra; Proboszcz, Małgorzata; Bielecki, Jacek; van Ingen, Jakko; Krenke, Rafał; Jagielski, Tomasz
• Is Part Of: Respiratory medicine. Volume 139(2018)
• Page Start: 91
• Page End: 100
• Publication Date: 2018-06
• Subjects: Nontuberculous mycobacteria (NTM) -- Mycobacterium kansasii -- Mycobacterial lung disease -- Fibro-cavitary disease -- Nodular/bronchiectatic disease -- Infiltrative disease; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2018.05.007
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Studies concerning sociodemographic, clinical, and laboratory features of Mycobacterium kansasii pulmonary disease are few and based on small patient cohorts. The objective of the study was to evaluate characteristics of patients from whom M. kansasii respiratory isolates were recovered and to provide a detailed description of M. kansasii disease. Basic procedures: Retrospective review of electronic medical records of all patients for whom at least one positive M. kansasii culture was obtained at the Department of Internal Medicine, Pulmonology and Allergology of the Warsaw Medical University between the year 2000 and 2015. Patients were categorized as having mycobacterial disease or as isolation cases based on the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) diagnostic criteria. Main findings: The study comprised of 105 patients (63 females, 42 males, mean age 64.6 ± 17.8 years). Of these, 86 (81.9%) were diagnosed as having M. kansasii disease. The proportion of positive smear microscopy was significantly higher in patients with M. kansasii disease compared to M. kansasii isolation (P < 0.001). There were no statistically significant differences between M. kansasii disease and isolation cases in terms of clinical symptoms or comorbidities. Patients with M. kansasii disease presented most commonly (43/86, 50%) fibro-cavitary disease upon radiology. Lesion distribution usually showed bilateral upper lobe involvement. Among the 191 isolates genotyped, all were identified as M. kansasii type I. Principal conclusions: The findings from this study support the relaxation of the diagnostic criteria for the definition of M. kansasii disease, set forth by ATS/IDSA. Molecular typing did not differentiate isolates from patients with true disease from those with isolation only; the role of bacterial virulence factors thus remains elusive. Highlights: M. kansasii was confirmed to display a high pathogenic potential. Its isolation even from a single respiratory sample, especially with AFB+ result should raise a clinical suspicion of M. kansasii disease. The results from this study urge for relaxation of bacteriological diagnostic criterion for M. kansasii pulmonary disease. New molecular markers of high discriminatory power are needed for differentiation between virulent and avirulent M. kansasii isolates.