Aspergillus isolation in nontuberculous mycobacterial pulmonary disease: Associated with antimycobacterial treatment initiation but not response. (April 2021)

• Record Type: Journal Article
• Authors: Raats, Daan; Aldhaheri, Sharina M.S.; Marras, Theodore K.; Mehrabi, Mahtab; Brode, Sarah K.
• Is Part Of: Respiratory medicine. Volume 179(2021)
• Publication Date: 2021-04
• Subjects: Aspergillus -- Nontuberculous mycobacterial pulmonary disease -- Culture conversion -- Radiologic evolution; ATS/IDSA American Thoracic Society/Infectious diseases Society of America -- BMI body mass index -- CF cystic fibrosis -- COPD Chronic obstructive pulmonary disease -- CPA chronic pulmonary aspergillosis -- CRP c-reactive protein -- CT computed tomography ESR -- erythrocyte sedimentation rate FC -- fibrocavitary FEV1: Forced expiratory volume in 1 s -- ICS inhaled corticosteroid -- IV intravenous -- MAC-PD Mycobacterium avium complex pulmonary disease -- NB nodular-bronchiectatic -- NTM nontuberculous mycobacteria -- NTM-PD nontuberculous mycobacterial pulmonary 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.2021.106338
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Purpose: Chronic pulmonary aspergillosis is a serious complication of nontuberculous mycobacterial pulmonary disease (NTM-PD), and diagnosis remains challenging. The present study examined associations between the respiratory isolation of Aspergillus and the clinical characteristics and treatment outcomes of patients with NTM-PD. Methods: All patients meeting NTM-PD criteria as defined by the ATS/IDSA statement, with at least one respiratory sample cultured for fungi, were included in this retrospective cohort analysis. Patients with at least one respiratory sample isolating Aspergillus were compared to patients who did not isolate Aspergillus . The primary outcomes were culture conversion and radiologic evolution 12 months after NTM-PD treatment initiation. Results: During a 12 year period, 497 patients meeting the inclusion criteria were seen in our tertiary care center, of whom 130 grew Aspergillus . Median follow up after NTM-PD diagnosis was 46 months. Inhaled corticosteroid use, a nodular-bronchiectatic CT pattern and NTM-PD treatment initiation were more frequent in patients who isolated Aspergillus compared to those who did not (p-value respectively 0.01, 0.03 and < 0.001). Rates of culture conversion (63.0% vs. 62.2%, respectively; p-value 1) and radiologic evolution (improvement or stability in 69.7% vs. 77.2%, respectively; p-value 0.25) were not significantly different between treatment groups. Likewise, culture reversion rate and 5-year mortality were not significantly different. Additionally, A. fumigatus and repeated detection of Aspergillus were not associated with treatment outcomes. Conclusion: There was no association between respiratory isolation of Aspergillus and NTM-PD treatment outcomes in this cohort. However, treatment for NTM-PD was initiated more frequently in patients who isolated Aspergillus .