Abstract
Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixty patients satisfied the diagnostic criteria of nontuberculous mycobacterial disease proposed by American Thoracic Society during the last seven years. Six patients (3.8%) were coincidental pulmonary infection due to two Mycobacterium species. We investigated the background, laboratory findings, microbiological findings, radiological findings, treatment and prognosis. Results: There were six patients, 3 males and 3 females, with a mean age of 71.7 years. The causative microorganisms of coincidental pulmonary infection consisted of Mycobacterium avium + Mycobacterium intracellulare in two patients, Mycobacterium avium + Mycobacterium kansasii in one, Mycobacterium intracellulare + Mycobacterium chelonae in one, Mycobacterium intracellulare + Mycobacterium abscessus in one, and Mycobacterium intracellulare + Mycobacterium tuberculosis in one. Regarding the radiological findings, the distribution of the lesion was frequently shown in both the right middle and left lingula lobes, but the extent of the lesion was limited within the unilateral lung field. Centrilobular small nodules with bronchiectasis were recognized in all patients and cavities or infiltration shadows were recognized in half of them on chest computed tomography. A definite diagnosis was obtained by bronchoalveolar lavage fluid in four patients and expectorated sputum in two. Combined chemotherapy was performed for two patients and that for pulmonary tuberculosis in one. Conclusions: Coincidental pulmonary infection due to Mycobactterium species occurred at a low percentage. Although most patients were elderly with underlying disease and clinical features were compatible with pulmonary Mycobacterium avium complex disease, the prognosis was comparatively good with and without treatment.
Highlights
Since the American Thoracic Society (ATS) proposed the diagnostic guidelines of pulmonary nontuberculous mycobacterial (NTM) disease in 2007 [1], the number of patients with pulmonary NTM disease has been increasing in Japan [2]
Six patients (3.8%) had coincidental pulmonary infection due to two Mycobacterium species, including Mycobacterium avium complex (MAC)
The causative microorganisms in patients with coincidental pulmonary infection due to Mycobacterium species consisted of Mycobacterium avium + Mycobacterium intracellulare in 2 patients, Mycobacterium avium + Mycobacterium kansasii in 1, Mycobacterium intracellu
Summary
Since the American Thoracic Society (ATS) proposed the diagnostic guidelines of pulmonary nontuberculous mycobacterial (NTM) disease in 2007 [1], the number of patients with pulmonary NTM disease has been increasing in Japan [2]. Among the microbiological diagnostic criteria of pulmonary NTM disease, if positive culture results from at least two separate expectorated sputum samples or positive culture results from at least one bronchial wash or lavage are obtained, we can confirm a definite diagnosis of pulmonary NTM disease in combination with clinical findings. Because bronchoscopy has been frequently performed to obtain a definite diagnosis of pulmonary NTM disease and its diagnostic usefulness was reported [3,4], we sometimes discover coincidental pulmonary infection due to Mycobacterium species. We clarified the clinical characteristics of patients with coincidental pulmonary infection due to Mycobacterium species during the last seven years in this study
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