American Thoracic Society Diagnostic Criteria Research Articles

Mycobacterium intracellulare among TB suspected patients in Bulgaria – microbiological aspects

Introduction: Nontuberculous mycobacteria (NTM) are representatives of the genus Mycobacterium with a worldwide distribution, associated mainly with water, soil, and biofilms. Some of NTMs, such as Mycobacterium avium complex (MAC), are etiological agents of human diseases – disseminated or with different localization, most often pulmonary. Aim: In the present study, we analyzed Mycobacterium intracellulare isolates recovered from clinical specimens of tuberculosis (TB) suspected patients in Bulgaria, 2018-2020. Materials and methods: The cultures were grown on solid and liquid media. For species identification, we used immune chromatographic (TB Ag MPT64) test and Line Probe Assay (LPA) from the positive cultures. Results: M. intracellulare was identified in 32 patients from 82,780 specimens. It was predominantly isolated in females – 62.5% vs. 37.5% in males. The most affected age group was 65 years and over (38%). The distribution of the isolates in Bulgaria was uneven. Most of them (65.6%) were concentrated in two districts of the country: Plovdiv and Sofia-city. All strains were sensitive to macrolides and aminoglycosides except one with macrolide resistance. NTM pulmonary disease was confirmed in 16 patients with M. intracellulare isolate. Conclusions: Analysing the 32 M. intracellulare isolates identified among TB suspected patients in Bulgaria between 2018 and 2020, we found that only half of them met the American Thoracic Society (ATS) diagnostic criteria for NTM pulmonary disease. For the remaining patients with M. intracellulare isolates we did not have sufficient data to support this diagnosis. Efforts by Bulgarian respiratory and microbiological societies are needed for adherence to the international guidelines.

Disease burden in individuals with symptomatic undiagnosed asthma or COPD

BackgroundThe actual burden of COPD and asthma may be much higher than appreciated, since a large proportion of individuals are not diagnosed. Our study objective was to compare health care utilization, burden of symptoms and quality of life in subjects with self-reported respiratory symptoms who were subsequently found to have undiagnosed airflow obstruction compared to those having no airflow obstruction. MethodsThis cross-sectional case-finding study used data from the Undiagnosed COPD and Asthma Population (UCAP) study. Adult subjects with respiratory symptoms who had no history of diagnosed lung disease were recruited in a two-step case-finding process using random digit-dialling of land lines and cell phones located within a 90-min radius of 16 Canadian study sites. Participants were assessed for COPD, asthma or no airflow obstruction using pre- and post-bronchodilator spirometry based on American Thoracic Society diagnostic criteria. Results1660 participants were recruited, of these 1615 had adequate spirometry and 331 (20.5%) subjects met spirometry criteria for undiagnosed asthma or COPD. Subjects with undiagnosed asthma or COPD had increased respiratory symptoms as assessed by the COPD Assessment Test (CAT), and higher St. George's Respiratory Questionnaire (SGRQ) scores indicating worse health-related quality of life, compared to subjects with no airflow obstruction. No between-group differences were found in health care utilization or work or school absenteeism. ConclusionUndiagnosed asthma and COPD are common in Canadian adults experiencing breathing problems and are associated with a greater burden of symptoms and poorer health-related quality of life. These results suggest that patients may benefit from early identification and treatment of undiagnosed asthma and COPD.

Efeito da coexistência de câncer sólido extrapulmonar avançado na progressão da doença pulmonar por complexo Mycobacterium avium

ABSTRACTObjective:Although Mycobacterium avium complex (MAC) lung disease has been shown to be associated with lung cancer and hematologic malignancies, there have been few studies of its relationships with other types of cancer. The aim of this study was to assess the effect that coexisting advanced extrapulmonary solid tumors have on the progression of MAC lung disease. Methods:This was a retrospective study of patients diagnosed with MAC lung disease, on the basis of the American Thoracic Society (ATS) criteria, between October of 2005 and March of 2019. The patients were divided into three groups: those with advanced-stage cancer (A-SC group); those with early-stage cancer (E-SC group); and those without cancer (control group). Progression of MAC lung disease was defined as exacerbation seen on imaging. Patient characteristics and the time to progression were compared among the three groups. Results:A total of 286 patients met the ATS diagnostic criteria for MAC lung disease, and 128 of those were excluded. Of the remaining 158 patients, 20 (7.0%) were in the A-SC group, 36 (12.6%) were in the E-SC group, and 102 (35.7%) were in the control group. The median time to progression in the A-SC, E-SC, and control groups was 432, 3,595, and 2,829 days, respectively (p < 0.01). A proportional hazards model showed that the significant predictors of MAC lung disease progression were advanced-stage cancer (hazard ratio [HR] = 6.096; 95% CI: 2.688-13.826; p < 0.01), cavitary lesions (HR = 2.750; 95% CI: 1.306-5.791; p < 0.01), and a high Nodule-Infiltration-Cavity-Ectasis score (HR = 1.046; 95% CI: 1.004-1.091; p = 0.033). Conclusions:A coexisting advanced extrapulmonary solid tumor could hasten the progression of MAC lung disease.

Early Immunosuppressive Therapy for Idiopathic Pneumonia Syndrome Prior to Bronchoscopy Is Associated with Favourable Outcomes

Introduction: Idiopathic pneumonia syndrome (IPS) is a dangerous complication following haematopoietic stem cell transplantation (HSCT). Immunosuppressive therapy (IST) using high-dose methylprednisone and etanercept produces complete response (CR) in the majority of IPS cases. However, exclusion of respiratory pathogens by bronchoscopy prior to IST commencement carries procedural risks that may worsen respiratory failure and IPS severity, with potential negative impact upon IST response and survival. Given this, we perform bronchoscopy post-IST commencement only in those patients with only mild (nasal oxygen) or severe (already intubated) respiratory failure. We commence IST within 24 hours of clinical and radiological suspicion of IPS, and cease IST if alternative aetiologies are subsequently proven. Aim: We aimed to evaluate the safety and efficacy of our local early-intervention IST strategy in patients with new-onset suspected IPS following HSCT. Methods: We performed a retrospective, single-centre descriptive cohort study of patients who received IST for IPS between 2014-2019. Details collected included: patient demographics, IPS diagnostic details/severity, IST response, and survival. The primary study objectives were the incidence of complete response (CR), defined by cessation of supplemental oxygen for at least 48 hours, and overall survival (OS) following IST. IST comprised high-dose corticosteroids (methylprednisolone 2mg/kg/day or equivalent) and etanercept (25mg twice weekly for 4 weeks, then weekly to complete 12 total doses). Results: Of the 480 HSCT performed during the study period, 17 patients developed suspected IPS and received IST. At IPS diagnosis, 10 (59%) required intensive care admission. Non-invasive (NIV) and invasive (IV) ventilation was required in 4 (24%) and 5 (29%) patients, respectively. All patients met clinical and radiological American Thoracic Society (ATS) criteria for IPS. Bronchoscopy was only performed in 9 (53%), comprising all 5 receiving IV and 4 who were only requiring supplemental nasal oxygen. All 4 patients receiving NIV were considered too high-risk for post-bronchoscopy intubation, so did not proceed. Of those who underwent bronchoscopy, none experienced worsening respiratory failure, however 1 received a revised diagnosis of bacterial pneumonia and ceased IST within 3 days of commencement, and survived. In the remaining 16 patients, CR to IST was achieved in 14 (88%) patients, with 1-year OS of 44%. However, at a mean 17 months follow-up, OS for the whole cohort was 31% (Figure 1), reflecting a high incidence of non-relapse mortality (NRM) at 63% (Table 1). There was no significant difference in response or survival between patients who did or did not undergo bronchoscopy. Conclusion: Our early-intervention IST strategy for IPS appears to produce similar response rates and survival as those reported in other prospective and retrospective series, without any obvious safety concerns. Although adherence to ATS diagnostic criteria and exclusion of occult infectious aetiologies is preferred, bronchoscopy may be safely delayed or omitted in a subset of patients. Early intervention may arrest the respiratory failure and ultimately avoid mechanical ventilation. Disclosures No relevant conflicts of interest to declare.

Non-Tuberculous Mycobacteria: Seven-Year Experience of a Tertiary Hospital.

Non-tuberculous mycobacteria are ubiquitous organisms. Precise determination of infection numbers is difficult, sincereporting them to public health departments is frequently not mandatory; furthermore, isolating a non-tuberculous mycobacteria doesnot necessarily translate into disease. The aims of this study were to ascertain non-tuberculous mycobacteria data of a tertiary hospital,determine the incidence and approach to colonization versus disease, and the incidence of predisposing comorbidities. Retrospective study in a tertiary hospital, involving patients with positive cultural exam for non-tuberculousmycobacteria in any biological sample, from 2010 to 2017. A total of 125 non-tuberculous mycobacteria isolates was identified, corresponding to 96 patients. Of these, 57.4% were male(n = 54); median age was 65 years (interquartile range = [50 - 82]). From these, 60.7% (n = 57) had some degree of immunosuppression,most frequently due to malignant tumour (49.0%) or HIV infection (39.2%). It was found that 29 patients (31.0%) had structuralrespiratory tract changes. Colonization was defined in 65.6% of patients (n = 63). While 71.0% of non-tuberculous mycobacteria infectionswere pulmonary, the remaining 29.0% presented as disseminated. According to available clinical records, 60.6% (n = 20) of thepresumably infected patients fulfilled American Thoracic Society diagnostic criteria for non-tuberculous mycobacteria disease. Several cases of non-tuberculous mycobacteria infection in this study presented as life-threatening, multi-systemic disease,highlighting the importance of accurate diagnosis and timely treatment. Other cases of presumed infection might instead havecorresponded to colonization, possibly resulting in futile therapy. While there are diagnostic criteria for treatment of non-tuberculous mycobacteria infections, no such guidelines existto assess colonization. One of the most challenging aspects remains the correct differentiation between colonization and early-stageinfection.

Clinical relevance of non-tuberculous mycobacteria isolated from respiratory specimens: seven year experience in a UK hospital

The frequency of isolation of non-tuberculous mycobacteria (NTM) species from respiratory specimens is increasing, however the clinical relevance of such identifications vary by mycobacterial species and geographical location. A retrospective study of 853 NTM isolates from respiratory samples from 386 patients over seven years was performed. Clinical records and radiographic information were examined. Clinical significance was assessed by American Thoracic Society diagnostic criteria. 25% of all patients with respiratory isolates met criteria for non-tuberculous mycobacterial pulmonary disease (NTM-PD). Significant symptoms were weight loss, fever, night sweats, productive cough and haemoptysis. HIV co-infection was a significant risk factor for disease. Cavities, nodules and tree-in-bud were significant radiographic findings. Mycobacterium avium complex (MAC) were the dominant species isolated from this patient cohort. Mycobacterium abscessus (M. abscessus) was the species most likely to cause clinically significant disease and be sputum smear positive, thus warranting particular attention.

Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens

Objective To determine the clinical significance of nontuberculous mycobacteria (NTM) isolated from respiratory specimens. Methods Clinical data of patients with NTM strains isolated from the respiratory tract between January 2014 and February 2017 were retrospectively analyzed. Clinical significance of NTM isolated strains was evaluated based on diagnostic criteria of NTM pulmonary diseases from American Thoracic Society (ATS). Quantitative data of two groups were analyzed by independent t test. Categorical data were analyzed by Pearson χ2 test or Fisher exact test. Results Totally 352 NTM strains from 257 patients had been isolated between January 2014 and February 2017. Among 15 identified NTM species, M. intracellular (51.7%, 182/352), M. abscessus (25.6%, 90/352), and M. avium (10.8%, 38/352) were predominant. Of the 157 patients with full clinical data involved in the analysis, 58 (36.9%) patients were determined to have definite disease, and 34 patients (21.7%) were designated as probable disease candidates, and 16 (10.2%) patients were regarded as uncertain disease, and 49(31.2%) patients were diagnosed as unlikely disease. The age of 58 patients with definite disease was (63.9±12.7) years, and 48.3% (28/58) were female. M. intracellulare (55.2%, 32/58) was the main cause of pulmonary NTM disease, followed by M. abscessus (25.9%, 15/58) and M. avium (12.1%, 7/58), while other NTM species only accounted for 6.8% (4/58). Definite cases with M. intracellulare, M. abscessus, M. avium, M. kansasii, M. marseillense, and M. columbia accounted for 35.2% (32/91), 57.7% (15/26), 7/15, 2/3, 1/3 and 1/2, respectively, among patients with corresponding isolations, while patients with other species of isolation did not meet the diagnostic criteria. Patients with clinical significant isolation of NTM were older than those without clinical significance (χ2=3.603, P=0.000), and proportion of anti-acid staining positivity of patients with clinical significance was higher than that of patients without clinical significance (χ2=18.815, P=0.000). The proportion of M. abscessus in patients with clinical significance was higher than that in patients without clinical significance (χ2=6.313, P=0.012). However, there was no significant difference between the two groups in the isolation of M. Gordon (Fisher exact test, P=0.028). The proportion of M. abscessus lung disease in women was 11/15, which was higher than that of M. intracellulare lung disease (41.5%, 17/41), and the difference between the two groups was statistically significant (χ2=4.462, P=0.035). There was no significant difference of clinical symptoms and underlying diseases in NTM lung disease among different groups (all P>0.05). In these patients with definite disease, 39.7% (23/58) of them manifested the upper lobe cavitary form, 53.4% (31/58) exhibited nodular bronchiectatic form, and only 6.9% (4/58) exhibited unclassified form. The upper lobe cavitary form (43.8%, 14/32) and the nodular bronchiectatic form (53.1%, 17/32) dominated in patients with M. intracellulare lung disease. M. abscessus lung disease was dominated by the nodular bronchiectatic form (11/15) while the upper lobe cavitary form only accounts for 3/15. There was no significant difference of image characteristics between NTM lung disease and other different groups (all P>0.05). Conclusions 36.9% of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. Different species have different clinical significance. M. intracellulare and M. abscessus are the most predominant NTM isolated species that cause NTM lung disease. Majority of patients manifest as the upper lobe cavitary form, followed by the nodular bronchiectatic form. Key words: Respiratory; Nontuberculous mycobacteria; Clinical relevance; Clinical significance

High rates of nontuberculous mycobacteria isolation from patients with presumptive tuberculosis in Iran.

Nontuberculous mycobacteria (NTM) can cause disease which can be indistinguishable from tuberculosis (TB), posing a diagnostic and therapeutic challenge, particularly in low- and middle-income settings. We aimed to investigate the mycobacterial agents associated with presumptive clinical pulmonary TB in Iran. A total of 410 mycobacterial isolates, obtained between March 2014 and January 2016, from 7600 clinical samples taken from consecutive cases of presumptive diagnosis of TB were identified. Phenotypic and molecular tests were used to identify the isolated organisms to the species level. Single-locus and multilocus sequence analysis based on 16S rRNA, rpoB, hsp65 and ITS locus were used to confirm the results. Of 410 consecutive strains isolated from suspected TB subjects, 62 isolates (15.1%) were identified as NTM. Patients with positive NTM cultures met American Thoracic Society diagnostic criteria for NTM disease. Mycobacterium simiae was the most frequently encountered (38.7%), followed by Mycobacterium fortuitum (19.3%), M. kansasii (17.7%) and M. avium complex (8.0%). Isolation of NTM, including M. simiae, from suspected TB cases is a serious public health problem and merits further attention by health authorities, physicians and microbiologists

52 Clinical characteristics and diagnosis of NTM infection in children with cystic fibrosis (CF) in the North East of England

Objective Non-tuberculous mycobacterial (NTM) infection is an emerging clinical problem in people with CF but the threshold for treatment is uncertain. American Thoracic Society (ATS) criteria exist for the diagnosis of NTM infection but are not CF specific and their usefulness in children is uncertain. We audited whether NTM affected patients in our service met these criteria relative to decisions regarding treatment. Methods Clinical, radiographic and microbiological data were collected on all NTM affected patients. The ATS diagnostic criteria are a. presence of pulmonary symptoms; b. nodular or cavitary opacities on CXR OR multifocal bronchiectasis plus nodules on HRCT; and c. positive cultures from 2 or more sputum samples. Results Ten children (7 male, median age 13.5 years, 6 × DF508/ DF508) isolated Mycobacterium abscessus between 1 and 18 times (median 5.5). Median % predicted FEV1 pre-NTM isolation was 82.5% and post was 82.0% (p=NS). Median weight-for-age Z score pre-isolation was 0.18 and post-isolation was –0.25 (Kruskal–Wallis p = 0.056). Four of ten patients fulfilled clinical, radiographic and microbiological criteria at isolation of NTM. Five patients were treated for NTM infection; of these three met the ATS criteria at the time of commencing treatment. Conclusion Acquiring NTM was not associated in a decline in lung function in children in our service. ATS criteria were of limited clinical utility in our clinic but the recent publication of consensus guidelines will help to improve this situation.

The Significance of Mycobacterium abscessus Subspecies abscessus Isolation During Mycobacterium avium Complex Lung Disease Therapy

Isolation of Mycobacterium abscessus subspecies abscessus (MAA) is common during Mycobacterium avium complex (MAC) lung disease therapy, but there is limited information about the clinical significance of the MAA isolates. We identified 53 of 180 patients (29%) treated for MAC lung disease who had isolation of MAA during MAC lung disease therapy. Patients were divided into those without (group 1) and those with (group 2) MAA lung disease. There were no significant demographic differences between patients with and without MAA isolation or between groups 1 and 2. Group 1 and 2 patients had similar total sputum cultures obtained (P = .7; 95% CI, -13.4 to 8.6) and length of follow-up (P = .8; 95% CI, -21.5 to 16.1). Group 2 patients had significantly more total positive cultures for MAA (mean±SD, 15.0 ± 11.1 vs 1.2 ± 0.4; P < .0001; 95% CI, -17.7 to -9.9), were significantly more likely to develop new or enlarging cavitary lesions while on MAC therapy (P > .0001), and were significantly more likely to meet all three American Thoracic Society diagnostic criteria for nontuberculous mycobacterial disease (21 of 21 [100%] vs 0 of 32 [0%]; P < .0001) compared with group 1 patients. Group 1 patients were significantly more likely to have single, positive MAA cultures than group 2 patients (25 of 31 vs 0 of 21; P < .0001). Microbiologic and clinical follow-up after completion of MAC lung disease therapy is required to determine the significance of MAA isolated during MAC lung disease therapy. Single MAA isolates are not likely to be clinically significant.

A shorter treatment duration may be sufficient for patients with Mycobacterium massiliense lung disease than with Mycobacterium abscessus lung disease

Mycobacterium abscessus complex is the second most common organism isolated from patients with nontuberculous mycobacterial (NTM) lung disease in South Korea. This study aimed to compare clinical features and treatment outcomes of M. abscessus and Mycobacterium massiliense lung disease. We retrospectively identified stored clinical isolates of M. abscessus complex as either M. abscessus or M. massiliense and reviewed medical records to compare clinical characteristics and treatment responses. All patients were treated empirically over several months with multidrug regimens, including a macrolide and one or more parenteral agents. Of the 249 patient isolates tested, 128 (59 with M. abscessus and 69 with M. massiliense) met the American Thoracic Society diagnostic criteria for NTM pulmonary disease, and treatment outcomes were analyzed in 48 patients (26 with M. abscessus and 22 with M. massiliense). The clinical and radiologic findings were similar between the two groups. Although the durations of parenteral and total treatment were significantly shorter in patients with M. massiliense than in those with M. abscessus (4.7 months vs 7.4 months, P = .006, and 12.1 months vs 16.3 months, P = .043), the treatment success rate was significantly higher in patients with M. massiliense (95.5%) than in M. abscessus cases (42.3%, P < .001). Patients with M. massiliense pulmonary infection responded better to this antibiotic strategy than those with M. abscessus infection. A shortened duration of treatment may be sufficient for M. massiliense pulmonary infection.

Frequency and clinical significance of respiratory isolates of non-tuberculous mycobacteria in Riyadh, Saudi Arabia.

The prevalence of pulmonary non-tuberculous mycobacteria (NTM) disease is increasing worldwide. The aim of this study was to assess the frequency and clinical significance of NTM isolated from respiratory specimens at King Abdul-Aziz Medical City-Riyadh, Saudi Arabia. The medical records of all patients who had at least one respiratory specimen that was positive for growth of NTM between 2006 and 2012 were retrospectively reviewed. The clinical significance of the isolates was determined using the diagnostic criteria for NTM disease published by the American Thoracic Society (ATS). A total of 380 respiratory specimens with positive culture for NTM from 142 patients were identified. Forty patients (28%) had definite pulmonary NTM disease with a mean (± standard deviation) age of 54 ± 16 years, 58% were male and 50% had had underlying chronic lung disease. Mycobacterium avium complex (MAC) (n = 19, 48%) and Mycobacterium abscessus (n = 10, 25%) were the most commonly encountered NTM. The clinical manifestations of NTM lung disease are non-specific, with symptoms indistinguishable from pulmonary tuberculosis (TB). The most common radiological features of NTM lung disease were nodular bronchiectasis (45%) and fibrocavitary lesions (40%). Twenty-eight percent of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. MAC and M. abscessus were the most encountered NTM isolated species that caused NTM lung disease in our population, which is a rate similar to many previous studies.

Year in review 2013: Lung cancer, respiratory infections, tuberculosis, cystic fibrosis, pleural diseases, bronchoscopic intervention and imaging

This Year in Review examines the most relevant articles published on lung cancer, respiratory infections, tuberculosis (TB), cystic fibrosis (CF), pleural diseases, and interventional pulmonology and imaging in Respirology and other respiratory medicine journals during 2013. Important findings are highlighted with comments in the following sections, each of which was contributed by an author as named in the beginning of each section.

Clinical significance of Mycobacterium szulgai isolates from respiratory specimens

The clinical relevance of Mycobacterium szulgai respiratory isolates has been controversial. The aim of this study was to determine the clinical significance of M. szulgai isolates from respiratory specimens and to identify the clinical features and outcomes of M. szulgai lung disease. We reviewed the medical records of 30 patients from whom M. szulgai was isolated between 2001 and 2010 at the Samsung Medical Center (Seoul, Korea). Of the 30 patients, 13 (43%) met the American Thoracic Society diagnostic criteria and were thus likely to have true M. szulgai lung disease. Approximately 57% (17/30) of M. szulgai isolates were recovered only once from patients with other pulmonary diseases, such as pulmonary tuberculosis and other non-tuberculous mycobacterial lung diseases. The 13 patients with M. szulgai lung disease included 12 men (92%), and the median age was 63 y. Among them, 7 (54%) were current smokers and 7 (54%) had a history of previous treatment for tuberculosis. Eight (62%) patients had the fibrocavitary form of M. szulgai lung disease. Nine (69%) patients received anti-mycobacterial treatment for a median duration of 8 months. Conversion to negative cultures was documented in all patients. There was no recurrence or disease-related mortality. Because the isolated M. szulgai from respiratory specimens could be regarded as pathogenic in less than 50% of cases, strict adherence to the recommended diagnostic criteria of non-tuberculous mycobacterial lung disease is essential.

Chest computed tomography predicts microbiological burden and symptoms in pulmonary Mycobacterium xenopi

The development of computed tomography (CT) findings usually precedes the diagnosis of pulmonary nontuberculous mycobacterial infection. The utility of specific CT scan features, although often available long before respiratory sample cultures, is not fully understood. We sought to assess associations among CT features, symptoms and microbiological disease criteria in pulmonary Mycobacterium xenopi isolation. We reviewed 70 consecutive immunocompetent patients with pulmonary M. xenopi isolation and classified them according to the American Thoracic Society (ATS) diagnostic criteria for disease. 'Definite disease' patients (n = 16) met modified ATS criteria. 'Possible disease' patients (n = 10) met microbiological criteria, had abnormal CT scans, but data regarding symptoms were unavailable. 'No disease' patients (n = 44) had only one positive sputum culture, or were asymptomatic or had no relevant CT findings. Two radiologists, without knowledge of the clinical or microbiological information, independently reviewed the scans. The mean (standard deviation) age of all patients was 63 (16) years, and 39% were women. Patients with 'definite disease' usually had nodules (88%) and cavities (63%), but less often bronchiectasis (50%) and tree-in-bud (50%). Patients with 'possible' or 'no disease', respectively, had nodules (100% or 80%), bronchiectasis (40% or 18%) or tree-in-bud (40% or 11%). Cavitation (P ≤ 0.0001) and nodules ≥ 5 mm (P = 0.0002) were associated with fulfilled microbiological criteria for disease. Bronchiectasis (P = 0.02) and nodules <5 mm (P = 0.002) were associated with symptoms of infection. Among immunocompetent patients with pulmonary M. xenopi isolation, cavitation and large nodules predict fulfilling microbiological disease criteria, while bronchiectasis and small nodules predict symptoms.

Nontuberculous Mycobacteria in Respiratory Tract Infections, Eastern Asia

Abstract To characterize the distribution of nontuberculous mycobacteria (NTM) species isolated from pulmonary samples from persons in Asia and their association with pulmonary infections, we reviewed the literature. Mycobacterium avium complex bacteria were most frequently isolated (13%–81%) and were the most common cause of pulmonary NTM disease (43%–81%). Also pathogenic were rapidly growing mycobacteria (M. chelonae, M. fortuitum, M. abscessus). Among all NTM isolated from pulmonary samples, 31% (582/1,744) were considered clinically relevant according to American Thoracic Society diagnostic criteria. Most patients were male (79%) and had a history of tuberculosis (37%). In Asia, high prevalence of rapidly growing mycobacteria and a history of tuberculosis are distinct characteristics of pulmonary NTM disease. This geographic variation is not well reflected in the American Thoracic Society criteria for NTM infections and could be incorporated in future guidelines.

Nontuberculous Mycobacteria in Respiratory Tract Infections, Eastern Asia

To characterize the distribution of nontuberculous mycobacteria (NTM) species isolated from pulmonary samples from persons in Asia and their association with pulmonary infections, we reviewed the literature. Mycobacterium avium complex bacteria were most frequently isolated (13%–81%) and were the most common cause of pulmonary NTM disease (43%–81%). Also pathogenic were rapidly growing mycobacteria (M. chelonae, M. fortuitum, M. abscessus). Among all NTM isolated from pulmonary samples, 31% (582/1,744) were considered clinically relevant according to American Thoracic Society diagnostic criteria. Most patients were male (79%) and had a history of tuberculosis (37%). In Asia, high prevalence of rapidly growing mycobacteria and a history of tuberculosis are distinct characteristics of pulmonary NTM disease. This geographic variation is not well reflected in the American Thoracic Society criteria for NTM infections and could be incorporated in future guidelines.

Nontuberculous Mycobacteria in Respiratory Tract Infections, Eastern Asia

To characterize the distribution of nontuberculous mycobacteria (NTM) species isolated from pulmonary samples from persons in Asia and their association with pulmonary infections, we reviewed the literature. Mycobacterium avium complex bacteria were most frequently isolated (13%-81%) and were the most common cause of pulmonary NTM disease (43%-81%). Also pathogenic were rapidly growing mycobacteria (M. chelonae, M. fortuitum, M. abscessus). Among all NTM isolated from pulmonary samples, 31% (582/1,744) were considered clinically relevant according to American Thoracic Society diagnostic criteria. Most patients were male (79%) and had a history of tuberculosis (37%). In Asia, high prevalence of rapidly growing mycobacteria and a history of tuberculosis are distinct characteristics of pulmonary NTM disease. This geographic variation is not well reflected in the American Thoracic Society criteria for NTM infections and could be incorporated in future guidelines.

P163 Incidence and clinical relevance of non-tuberculous mycobacteria isolates based on 10 years experience at York Hospital, North Yorkshire (UK)

BackgroundNon-tuberculous mycobacteria (NTM) are widely distributed in the environment and are difficult to diagnose and treat. Previous non-UK studies have reported increasing incidence and geographical variation in NTM isolates.1 We...

Cooperation and Heterogeneity of the Autistic Mind

Individuals with autism spectrum conditions (ASCs) have a core difficulty in recursively inferring the intentions of others. The precise cognitive dysfunctions that determine the heterogeneity at the heart of this spectrum, however, remains unclear. Furthermore, it remains possible that impairment in social interaction is not a fundamental deficit but a reflection of deficits in distinct cognitive processes. To better understand heterogeneity within ASCs, we employed a game-theoretic approach to characterize unobservable computational processes implicit in social interactions. Using a social hunting game with autistic adults, we found that a selective difficulty representing the level of strategic sophistication of others, namely inferring others' mindreading strategy, specifically predicts symptom severity. In contrast, a reduced ability in iterative planning was predicted by overall intellectual level. Our findings provide the first quantitative approach that can reveal the underlying computational dysfunctions that generate the autistic "spectrum."