Lung

, Volume 188, Issue 4, pp 289–299 | Cite as

Nontuberculous Mycobacterial Lung Infections in Ontario, Canada: Clinical and Microbiological Characteristics

  • Theodore K. Marras
  • Mauli Mehta
  • Pamela Chedore
  • Kevin May
  • Mohammed Al Houqani
  • Frances Jamieson
Article

Abstract

Study Objectives The aim of this study was to determine gender and clinical phenotype frequencies in pulmonary nontuberculous mycobacterial (NTM) infection and the frequency of disease in NTM isolates. Design The study is a retrospective observational cohort study of two overlapping cohorts: population cohort and clinical cohort. Setting The study was conducted at the University Health Network and Ontario Mycobacteriology Laboratory in Toronto, Ontario, Canada. Patients or Participants The population cohort consisted of all patients with one or more pulmonary NTM isolates in Ontario in 2003. The clinical cohort consisted of all patients with one or more pulmonary NTM isolates at our hospital in 2002–2003. Interventions The study entailed the review of laboratory records and demographics (both cohorts) and detailed clinical records (clinical cohort). Measurements and Results In the population cohort (N = 1651), females comprised 48% overall and 51% with microbiological disease criteria. In the clinical cohort (N = 552), females comprised 48% overall and 55% with NTM disease. In the population cohort, 45% fulfilled microbiological disease criteria, and in the clinical cohort 46% of patients had disease. Patients with MAC isolates fulfilled microbiological disease criteria in 51% of population cohort cases and all disease criteria in 52% of clinical cohort cases. Women more commonly fulfilled microbiological disease criteria in the population cohort (51 vs. 45%, P = 0.02) and all disease criteria in the clinical cohort (53 vs. 40%, P = 0.03). Among clinical cohort patients, 26% (13 women, 44 men) had fibrocavitation, while 62% (101 women, 37 men) had nodular bronchiectasis. Conclusions Women comprised a small majority with disease. Nodular bronchiectasis in women was most common, but significant proportions of each gender with each radiographic type were observed. NTM isolation, particularly MAC, was frequently associated with disease.

Keywords

Epidemiology Mycobacterial infections Atypical Mycobacteria Atypical Sex 

Notes

Acknowledgment

We are grateful to Dr. Kevin Winthrop, who provided thoughtful commentary regarding estimating the fraction of patients who have NTM disease based on the presence of microbiology criteria.

References

  1. 1.
    Marras TK, Chedore P, Ying AM, Jamieson F (2007) Isolation prevalence of pulmonary non-tuberculous mycobacteria in Ontario 1997–2003. Thorax 62:661–666CrossRefPubMedGoogle Scholar
  2. 2.
    Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco F, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ Jr, Winthrop K (2007) Diagnosis, treatment and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 175:367–416CrossRefPubMedGoogle Scholar
  3. 3.
    Prince DS, Peterson DD, Steiner RM, Gottlieb JE, Scott R, Israel HL, Figueroa WG, Fish JE (1989) Infection with Mycobacterium avium complex in patients without predisposing conditions. New Engl J Med 321:863–868PubMedCrossRefGoogle Scholar
  4. 4.
    Huang JH, Kao PN, Adi V, Ruoss SJ (1999) Mycobacterium avium-intracellulare pulmonary infection in HIV-negative patients without preexisting lung disease: diagnostic and management limitations. Chest 115:1033–1040CrossRefPubMedGoogle Scholar
  5. 5.
    Hanna BA, Ebrahimzadeh A, Elliott LB, Morgan MA, Novak SM, Rusch-Gerdes S, Acio M, Dunbar DF, Holmes TM, Rexer CH, Savthyakumar C, Vannier AM (1999) Multicenter evaluation of the BACTEC MGIT 960 system for recovery of mycobacteria. J Clin Microbiol 37:748–752PubMedGoogle Scholar
  6. 6.
    Butler WR, Guthertz LS (2001) Mycolic acid analysis by high-performance liquid chromatography for identification of Mycobacterium species. Clin Microbiol Rev 14:704–726CrossRefPubMedGoogle Scholar
  7. 7.
    Arnow PM, Bakir M, Thompson K, Bova JL (2000) Endemic contamination of clinical specimens by Mycobacterium gordonae. Clin Infect Dis 31:472–476CrossRefPubMedGoogle Scholar
  8. 8.
    Kim RD, Greenberg DE, Ehrmantraut ME, Guide SV, Ding L, Shea Y, Brown MR, Chernick M, Steagall WK, Glasgow CG, Lin JP, Jolley C, Sorbara L, Raffeld M, Hill S, Avila N, Sachdev V, Barnhart LA, Anderson VL, Claypool L, Hilligoss DM, Garofalo M, Fitzgerald A, Anaya-O’Brien S, Darnell D, DeCastro R, Menning HM, Ricklefs SM, Porcella SF, Olivier KN, Moss J, Holland SM (2008) Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome. Am J Respir Crit Care Med 178:1066–1074CrossRefPubMedGoogle Scholar
  9. 9.
    Fogan L (1970) Atypical mycobacteria. Medicine 49:243–255CrossRefPubMedGoogle Scholar
  10. 10.
    Ahn CH, Lowell JR, Onstad GD, Shuford EH, Hurst GA (1979) A demographic study of disease due to Mycobacterium kansasii or M intracellulare-avium in Texas. Chest 75:120–125CrossRefPubMedGoogle Scholar
  11. 11.
    O’Brien RJ, Geiter LJ, Snider DE Jr (1987) The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis 135:1007–1014PubMedGoogle Scholar
  12. 12.
    Butler W, Crawford J, Shutt K (1999) Nontuberculous mycobacteria reported to the Public Health Laboratory Information System by state public health laboratories, United States, 1993–1996. Centers for Disease Control and Prevention, Atlanta.Google Scholar
  13. 13.
    Donnabella V, Salazar-Schicchi J, Bonk S, Hanna B, Rom WN (2000) Increasing incidence of Mycobacterium xenopi at Bellevue Hospital: an emerging pathogen or a product of improved laboratory methods? Chest 118:1365–1370CrossRefPubMedGoogle Scholar
  14. 14.
    Gale GL (1976) Atypical mycobacteria in a tuberculosis hospital. Can Med Assoc J 114:612–614PubMedGoogle Scholar
  15. 15.
    Warring FC Jr (1968) Mycobacteria in a New England Hospital. Am Rev Respir Dis 98:965–977PubMedGoogle Scholar
  16. 16.
    Gorse GJ, Fairshter RD, Friedly G, Dela Maza L, Greene GR, Cesario TC (1983) Nontuberculous mycobacterial disease: experience in a Southern California hospital. Arch Intern Med 143:225–228CrossRefPubMedGoogle Scholar
  17. 17.
    Reich JM, Johnson RE (1991) Mycobacterium avium complex pulmonary disease: incidence, presentation, and response to therapy in a community setting. Am Rev Respir Dis 143:1381–1385PubMedGoogle Scholar
  18. 18.
    Bodle EE, Cunningham JA, Della-Latta P, Schluger N, Saiman L (2008) Epidemiology of nontuberculous mycobacteria in patients without HIV infection, New York City. Emerg Infect Dis 14:390–396CrossRefPubMedGoogle Scholar
  19. 19.
    Cassidy PM, Hedberg K, Saulson A, McNelly E, Winthrop KL (2009) Nontuberculous mycobacterial disease prevalence and risk factors: a changing epidemiology. Clin Infect Dis 49(12):e124–e129CrossRefPubMedGoogle Scholar
  20. 20.
    Jenkins PA (1981) The epidemiology of opportunist mycobacterial infections in Wales, 1952–1978. Rev Infect Dis 3:1021–1023PubMedGoogle Scholar
  21. 21.
    Gerogianni I, Papala M, Kostikas K, Petinaki E, Gourgoulianis KI (2008) Epidemiology and clinical significance of mycobacterial respiratory infections in Central Greece. Int J Tuberc Lung Dis 12:807–812PubMedGoogle Scholar
  22. 22.
    Van Ingen J, Bendien SA, de Lange WCM, Hoefsloot W, Dekhuijzen PNR, Boeree MJ, van Soolingen D (2009) Clinical relevance of nontuberculous mycobacteria isolated in Nijmegen-Arnhem region, The Netherlands. Thorax 64:502–506CrossRefPubMedGoogle Scholar
  23. 23.
    Kubin M, Svandova E, Medek B, Chobot S, Olsovsky Z (1980) Mycobacterium kansasii infection in an endemic area of Czechoslovakia. Tubercle 61:207–212CrossRefPubMedGoogle Scholar
  24. 24.
    Kaustova J, Chmelik M, Ettlova D, Hudec V, Lazarova H, Richtrova S (1995) Disease due to Mycobacterium kansasii in the Czech Republic: 1984–1989. Tuber Lung Dis 76:205–209CrossRefPubMedGoogle Scholar
  25. 25.
    Leal Arranz MV, Gaafar A, Unzaga Barañano MJ, Crespo Notario JA, Cisterna Cáncer R, Garcia Cebrián F (2005) Clinical and epidemiological study of disease caused by Mycobacterium kansasii in the metropolitan area of Bilbao, Spain. Arch Bronconeumol 41:189–196PubMedGoogle Scholar
  26. 26.
    Van Ingen J, Boeree MJ, de Lange WCM, Hoefsloot W, Bendien SA, Magis-Escurra C, Dekhuijzen PNR, van Soolingen D (2008) Mycobacterium xenopi clinical relevance and determinants, the Netherlands. Emerg Infect Dis 14:385–389CrossRefPubMedGoogle Scholar
  27. 27.
    Marusic A, Katalinic-Jankovic V, Popovic-Grle S, Jankovic M, Mazuranic I, Puljic I, Seric Milic H (2009) Mycobacterium xenopi pulmonary disease—epidemiology and clinical features in non-immunocompromised patients. J Infect 58:108–112CrossRefPubMedGoogle Scholar
  28. 28.
    Dailloux M, Abalain ML, Laurain C, Lebrun L, Loos-Ayav C, Lozniewski A, Maugein J (2006) Respiratory infections associated with nontuberculous mycobacteria in non-HIV patients. Eur Respir J 28:1211–1215CrossRefPubMedGoogle Scholar
  29. 29.
    Tsukamura M, Kita N, Shimoide H, Arakawa H, Kuze A (1988) Studies on the epidemiology of nontuberculous mycobacteriosis in Japan. Am Rev Respir Dis 137:1280–1284PubMedGoogle Scholar
  30. 30.
    Hosker HSR, Lam CW, Ng TK, Ma HK, Chan SL (1995) The prevalence and clinical significance of pulmonary infection due to non-tuberculous mycobacteria in Hong Kong. Respir Med 89:3–8CrossRefPubMedGoogle Scholar
  31. 31.
    Shih JY, Hsueh PR, Lee LN, Wang HC, Yang PC, Kuo SH, Luh KT (1997) Nontuberculous mycobacteria isolates: clinical significance and disease spectrum. J Formos Med Assoc 96:621–626PubMedGoogle Scholar
  32. 32.
    Koh WJ, Kwon OJ, Jeon K, Kim TS, Lee KS, Park YK, Bai GH (2006) Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest 129:341–348CrossRefPubMedGoogle Scholar
  33. 33.
    Okumura M, Iwai K, Ogata H, Ueyama M, Kubota M, Aoki M, Kokuto H, Tadokoro E, Uchiyama T, Saotome M, Yoshiyama T, Yoshimori K, Yoshida N, Azuma A, Kudoh S (2008) Clinical factors on cavitary and nodular bronchiectatic types in pulmonary Mycobacterium avium complex disease. Intern Med 47:1465–1472CrossRefPubMedGoogle Scholar
  34. 34.
    O’Brien DP, Currie BJ, Krause VL (2000) Nontuberculous mycobacterial disease in Northern Australia: a case series and review of the literature. Clin Infect Dis 31:958–968CrossRefPubMedGoogle Scholar
  35. 35.
    Freeman J, Morris A, Blackmore T, Hammer D, Munroe S, McKnight L (2007) Incidence of nontuberculous mycobacterial disease in New Zealand, 2004. N Z Med J 120(1256):U2580PubMedGoogle Scholar
  36. 36.
    Khan K, Wang J, Marras TK (2007) Nontuberculous mycobacterial sensitization in the United States: national trends over three decades. Am J Respir Crit Care Med 176:306–313CrossRefPubMedGoogle Scholar
  37. 37.
    Reich JM, Johnson RE (1992) Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern: the Lady Windermere Syndrome. Chest 101:1605–1609CrossRefPubMedGoogle Scholar
  38. 38.
    Choudhri S, Manfreda J, Wolfe J, Parker S, Long R (1995) Clinical significance of nontuberculous mycobacteria isolates in a Canadian tertiary care center. Clin Infect Dis 21:128–133PubMedGoogle Scholar
  39. 39.
    Robinson BL, Grzybowski S, Bowmer EJ, McDiarmid J, Whittaker EI, Tanner K (1969) Atypical mycobacterial disease in British Columbia, 1960–1967. Can Med Assoc J 101:17–24PubMedGoogle Scholar
  40. 40.
    Schaefer WB, Birn KJ, Jenkins PA, Marks J (1969) Infection with the avian-Battey group of mycobacteria in England and Wales. Br Med J 2:412–415CrossRefPubMedGoogle Scholar
  41. 41.
    Marras TK, Daley CL (2002) Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med 23:553–567CrossRefPubMedGoogle Scholar
  42. 42.
    Varadi RG, Marras TK (2009) Pulmonary Mycobacterium xenopi infection in non-HIV-infected patients: a systematic review. Int J Tuberc Lung Dis 13:1210–1218PubMedGoogle Scholar
  43. 43.
    Han XY, Tarrand JT, Infante R, Jacobson KL, Truong M (2005) Clinical significance and epidemiologic amalyses of Mycobacterium avium and Mycobacterium intracellulare among patients without AIDS. J Clin Microbiol 43:4407–4412CrossRefPubMedGoogle Scholar
  44. 44.
    Maesaki S, Kohno S, Koga H, Miyazaki Y, Kaku M (1993) A clinical comparison between Mycobacterium avium and Mycobacterium intracellulare. Chest 104:1408–1411CrossRefPubMedGoogle Scholar
  45. 45.
    Toyoda T, Aoyagi T, Saito H (1993) Clinical features of the lung diseases due to Mycobacterium avium and M. intracellulare. Kekkaku 68:63–69PubMedGoogle Scholar
  46. 46.
    Tortoli E, Rindi L, Garcia MJ, Chiaradonna P, Dei R, Garzelli C, Kroppenstedt RM, Lari N, Mattei R, Mariottini A, Mazzarelli G, Murcia MI, Nanetti A, Piccoli P, Scarparo C (2004) Proposal to elevate the genetic variant MAC-A, included in the Mycobacterium avium complex, to species rank as Mycobacterium chimaera sp. nov. Int J Syst Evol Microbiol 54:1277–1285CrossRefPubMedGoogle Scholar
  47. 47.
    Turenne CY, Thibert L, Williams K, Burdz TV, Cook VJ, Wolfe JN, Cockcroft DW, Kabani A (2004) Mycobacterium saskatchewanense sp. nov., a novel slowly growing scotochromogenic species from human clinical isolates related to Mycobacterium interjectum and Accuprobe positive for Mycobacterium avium complex. Int J Syst Evol Microbiol 54:659–667CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Theodore K. Marras
    • 1
    • 5
  • Mauli Mehta
    • 1
  • Pamela Chedore
    • 2
  • Kevin May
    • 2
  • Mohammed Al Houqani
    • 3
  • Frances Jamieson
    • 4
  1. 1.Joint Division of Respirology, Department of MedicineUniversity of Toronto, University Health Network and Mount Sinai HospitalTorontoCanada
  2. 2.TB and Mycobacteriology Laboratory, Public Health Laboratory - TorontoOntario Agency for Health Protection and PromotionTorontoCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.Public Health Laboratory, Ontario Agency for Health Protection and Promotion, and Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
  5. 5.Toronto Western HospitalTorontoCanada

Personalised recommendations