Nontuberculous Mycobacteriosis Research Articles

Blood microbiota in HIV-infected and HIV-uninfected patients with suspected sepsis detected by metagenomic next-generation sequencing

BackgroundInformation on the comparison of blood microbiota between human immunodeficiency virus (HIV)-infected and HIV-uninfected patients with suspected sepsis by metagenomic next-generation sequencing (mNGS) is limited.MethodsRetrospectively analysis was conducted in HIV-infected and HIV-uninfected patients with suspected sepsis at Changsha First Hospital (China) from March 2019 to August 2022. Patients who underwent blood mNGS testing were enrolled. The blood microbiota detected by mNGS were analyzed.ResultsA total of 233 patients with suspected sepsis who performed blood mNGS were recruited in this study, including 79 HIV-infected and 154 HIV-uninfected patients. Compared with HIV-uninfected patients, the proportions of mycobacterium (p = 0.001), fungus (p < 0.001) and viruses (p < 0.001) were significantly higher, while the proportion of bacteria (p = 0.001) was significantly lower in HIV-infected patients. The higher positive rates of non-tuberculous mycobacteriosis (NTM, p = 0.022), Pneumocystis jirovecii (P. jirovecii) (p = 0.014), Talaromyces marneffei (T. marneffei) (p < 0.001) and cytomegalovirus (CMV) (p < 0.001) were observed in HIV-infected patients, compared with HIV-uninfected patients. In addition, compared with HIV-uninfected patients, the constituent ratio of T. marneffei (p < 0.001) in the fungus spectrum were significantly higher, while the constituent ratios of Candida (p < 0.001) and Aspergillus (p = 0.001) were significantly lower in HIV-infected patients.ConclusionsSignificant differences in the blood microbiota profiles exist between HIV-infected and HIV-uninfected patients with suspected sepsis.

Особливості епізоотологічного нагляду та контролю за мікобактеріозами продуктивних тварин в умовах молочнотоварних господарств України

The increase in mycobacteriosis, an infectious disease caused by non-tuberculous mycobacteriosis, has become an urgent issue for humane medicine. The mycobacteriosis of animals is a subject of intense study by veterinary scientists across most countries globally. In Ukraine, the number of farms with productive animals exhibiting paraallergic reactions to tuberculin is steadily rising, making the diagnosis of tuberculosis more complicated. In dairy cattle breeding, this issue also has significant economic implications. The forced slaughter of breeding young stock and high-producing cows is often a consequence. On the other hand, the identification of various non-tuberculous mycobacteria species in human mycobacteriosis patients, which can sensitize the cows, gives the issue of preventing animal mycobacteriosis both medical and social significance. All of the factors mentioned previously led to the decision to permanently retain cows that react positively to tuberculin testing on a dairy farm in the Volyn region, which has historically been free of tuberculosis. A comprehensive study was conducted from 2018 to 2023, utilizing methods of epizootological analysis as well as clinical, pathological, histological, bacteriological, and statistical research techniques. It was shown that an epizootic process, caused by the infection of cattle with non-tuberculosis mycobacteria, is occurring on the dairy farm. Mycobacterium scrofulaceum, M. fortuitum, and Nocardia spp. were isolated and identified from the lymph nodes and lymphoid tissue of the large intestine submucosa in the infected animals. These pathogens cause significant histological and pathological changes, indicating the presence of a clinically covert infectious process accompanied by sensitization of the animal organism. Epizootological analysis of the results from simultaneous allergic testing, as well as multiple bacteriological studies of samples from animals that reacted positively to both purified protein derivate tuberculin and atypical mycobacteria allergens, established that the allergic reactions to tuberculin were paraallergic in nature. This indicated the presence of an active infectious process within the animals’ bodies.

Клинический случай прогрессирующего микобактериоза легких, потенциально связанный с генетической предрасположенностью, у пациентки с легким течением бронхиальной астмы

Mycobacteriosis is an infectious disease caused by opportunistic non-tuberculous microbacteria in patients with chronic respiratory pathology and decreased immunological reactivity. The number of patients with this pathology is increasing not only in Russia, but throughout the world. Scientists' attention was drawn to the fact that the isolation of non-tuberculous mycobacteria from patient’s sputum samples does not correlate with the incidence of non-tuberculous mycobacteriosis and the need for its treatment. This may be due to the presence of gene polymorphisms that affect the structure and functional characteristics of innate immune factors. The article presents a rare clinical case of non-tuberculous mycobacteriosis caused by Mycobacterium avium in a 50-year-old woman without severe concomitant diseases and secondary immunodeficiency. The genetic study revealed polymorphic gene alleles, which may predispose this patient for the infection and severe course of this disease.

Intestinal nontuberculous mycobacteria infection: A case report.

Intestinal nontuberculous mycobacteriosis due to nontuberculous mycobacteria infection has clinical manifestations similar to intestinal tuberculosis and inflammatory bowel disease, causing difficulties in clinical diagnosis. A 42-year-old male patient was admitted to the Sino-Japanese Friendship Hospital of Jilin University in June 2021 for diarrhea and intermittent hematochezia since April 2021. He was diagnosed with inflammatory intestinal disease by colonoscopy and midtransverse colon biopsy. However, the symptoms did not relieve after 2 months of mesalazine treatment. In August 2021, the patient was admitted to the outpatient department for suspected "intestinal tuberculosis." A diagnosis of intestinal nontuberculous mycobacteriosis was confirmed based on pathology and nucleotide-based matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). After 2 weeks of antimycobacterial therapy, the patient's diarrhea was relieved, and hematochezia no longer appeared. In November 2021, recolonoscopy revealed scattered erosions and ulcers in ileocecal valve and ascending colon, while both nucleotide-based MALDI-TOF MS and next-generation sequencing could still detect Mycobacterium intracellulare. This study reported a patient with an intestinal nontuberculous mycobacteriosis diagnosed by colonoscopy biopsy and nucleotide-based MALDI-TOF MS, and symptoms were relieved after antimycobacterial treatment.

Features of radiological manifestations in the diagnosis of nontuberculous mycobacteriosis. Literature review Сlinical observation

Purpose of the study. The purpose of this literature review is to determine the radiographic features in the diagnosis of non-tuberculous mycobacteriosis (NTMB) and to assess the possibility of radiological diagnosis of a combination of tuberculosis and non-tuberculous mycobacteriosis of the lungs in a patient with HIV infection.Materials and methods. A review of the literature on the bases of scientific articles PubMed, ELibrary and Google Scholar. Attention was focused on full-text articles. The article presents a clinical observation of a patient being treated at the Clinical TB Dispensary in Omsk from 2019 to 2022 with a diagnosis of disseminated pulmonary tuberculosis, bilateral, in the infiltration phase, tuberculous spondylitis ThVII–IX, complicated by a paravertebral abscess.Results. The radiological changes characteristic of NTMB are: lesion of the right middle and lingual lobes of the lungs with the presence of diffuse bronchiectasis, changes in the type of “tree in the kidneys”, compaction of lung tissue by the type of “frosted glass” with the presence of centrilobular nodules, asymmetric small dense foci with peribronchial location, apical location of thin-walled cavities with thickening of the costal pleura, as well as foci of inflammatory infiltration. The absence of specific symptoms for this pathology requires further research in this area. The identification of characteristic radiological features will speed up the diagnosis of infection and determine the correct management tactics for patients.Conclusion. The radiosemiotics of NTMB is characterized by a large variability of manifestations. The most informative method of radiation diagnosis of NTMB is multispiral computed tomography (MSCT). Thanks to MSCT, a radiologist has the opportunity to accurately assess the localization and nature of foci, as well as assess the dynamics and prevalence of the process. The most characteristic radiological symptoms are the defeat of the right middle and lingual lobes of the lungs with the presence of diffuse bronchiectasis, changes in the type of “tree in the kidneys”, compaction of lung tissue by the type of “frosted glass” and the presence of centrilobular nodules, asymmetric small dense foci with peribronchial arrangement, apical arrangement of thin-walled cavities with thickening of the costal pleura, as well as foci inflammatory infiltration. The absence of specific symptoms for this pathology requires further research in this area. The identification of characteristic radiological features will speed up the diagnosis of infection and determine the correct management tactics for patients.

833. Interaction between Aspergillus fumigatus and non-tuberculous mycobacteria

Abstract Background Patients with pulmonary non-tuberculous mycobacteriosis (NTM) have been increasing in Japan in recent years. Furthermore, NTM cases complicated with pulmonary aspergillosis are associated with a poor prognosis. However, little is known about the interaction between Aspergillus spp. and non-tuberculous mycobacterium. Methods To investigate the effect of NTM metabolites on A. fumigatus growth and gene expression, supernatants of M. avium (ATCC 700737) and M. abscessus (ATCC 19977) were added to A. fumigatus (Figure 1 and 2). Results The biofilms and biomass of A. fumigatus exposed to culture supernatant of each NTM were significantly increased compared to the control (Figure 3). The expression of genes involved in the synthesis of secondary metabolites of A. fumigatus, such as gliotoxin, was decreased after the exposure to supernatant by RNA sequencing analysis (Table 1,2). Conclusion Our results suggest that exposure to culture supernatant of NTM may support the growth of A. fumigatus while suppressing the production of some secondary metabolites. We are now trying to reproduce this phenotype in mouse model and to identify the causative agent from NTM culture supernatant and elucidate the mechanism further. Disclosures Masato Tashiro, MD, PhD, Asahi Kasei Pharma Corporation: Advisor/Consultant|Asahi Kasei Pharma Corporation: Honoraria|Sumitomo Pharma Co., Ltd.: Honoraria Koichi Izumikawa, M.D., Ph.D., Asahi Kasei Pharma Corporation: Grant/Research Support|Asahi Kasei Pharma Corporation: Honoraria|Astellas Pharma Inc.: Honoraria|DAIICHI SANKYO COMPANY, LIMITED: Grant/Research Support|DAIICHI SANKYO COMPANY, LIMITED: Honoraria|KYORIN Pharmaceutical Co., Ltd.: Honoraria|Merck &amp; Co., Inc.: Honoraria|Pfizer Japan Inc.: Honoraria|Shionogi &amp; Co., Ltd.: Grant/Research Support|Shionogi &amp; Co., Ltd.: Honoraria|Sumitomo Pharma Co., Ltd.: Grant/Research Support|Sumitomo Pharma Co., Ltd.: Honoraria|TAIHO PHARMACEUTICAL CO., LTD.: Grant/Research Support

Analysis of the utility of transbronchial lung biopsy culture under endobronchial ultrasonography with a guide-sheath

Transbronchial lung biopsy (TBLB) culture is not common in clinical practice, and TBLB culture for patients with mycobacterial disease provide limited value because the diagnostic accuracy of TBLB culture is very low. Recently, bronchoscopic devices have been further developed, such as endobronchial ultrasonography with a guide-sheath (EBUS-GS). Therefore, this study investigated the utility of TBLB culture obtained by using EBUS-GS compared to washing cultures. A total of 31 patients who underwent TBLB culture by using EBUS-GS (GS-TBLB) were collected retrospectively at Fukujuji Hospital from January 2018 to December 2022. The diagnostic accuracies of GS-TBLB culture and bronchial and device washing cultures (namely, washing culture) were compared. The patients comprised 13 individuals with nontuberculous mycobacteriosis, 7 with pulmonary aspergillosis, 6 with lung abscess, and 5 with pulmonary tuberculosis. The diagnostic accuracy of GS-TBLB culture was lower to that of TBLB culture than those of washing culture (n = 11 [35.5%] vs. n = 20 [64.5%], p = 0.016), and there was only one patient with positive GS-TBLB culture results and negative washing culture results. Comparing between patients with mycobacteria and non-mycobacteria, GS-TBLB culture positivity were no significant difference between patients with mycobacteria and non-mycobacteria (n = 6 [33.3%] vs. n = 5 [38.5%], p = 1.000), however, patients with mycobacteria diagnosed by washing culture more than those with non-mycobacteria (n = 15 [83.3%] vs. n = 5 [38.5%], p = 0.021). Our results demonstrate that the utility of TBLB culture for the diagnosis of pulmonary infections might provide limited value even if EBUS-GS is performed and lung tissue is successfully obtained.

Clinical Characteristics of Tracheobronchopathia Osteochondroplastica: A Retrospective Study of 33 Patients.

Tracheobronchopathia osteochondroplastica (TO) is a relatively rare benign tracheobronchial disease, which is often misdiagnosed or missed. To date, there is no specific treatment for TO. The aim of this study was to investigate the clinical manifestations, imaging features, bronchoscopy results, pathological findings, and diagnostic points of TO. A total of 33 patients diagnosed with TO were enrolled. Clinical data were collected using retrospective methods in the period from January 2021 and November 2022. Descriptive analysis was used. Patients included 17 (51.5%) male and 16 (48.5%) female, with a median age of 54 years. The main clinical manifestations included cough in 15 cases, fever in 6 cases, chest tightness in 4 cases, haemoptysis in 3 cases, and chest pain in 4 cases. The time from the onset of symptoms to diagnosis was 1 week to 96 months. Some patients were diagnosed with other lung diseases, including 16 patients with tuberculosis, 2 patients with lung cancer, 3 patients with nontuberculous mycobacteriosis, 3 patients with tuberculous pleurisy, 2 patients with bronchiectasis, and 1 patient with pneumonia. Chest computed tomography (CT) scan demonstrated calcified nodules in 10 (30.3%) patients. In bronchoscopy, entire tracheal involvement was found in 21 (63.6%) patients, 12 (36.4%) patients were found to have involvement of only part of the trachea. The patients were divided into three groups according to the bronchoscopic presentation, the largest proportion was stage II (19/33), followed by stage I (8/33) and stage III (6/33). Histopathological findings showed squamous metaplasia, cartilaginous, and bony tissues. TO is a slowly progressing disease with non-specific clinical symptoms and a low positive rate of imaging diagnosis, making it susceptible to misdiagnosis and missed diagnosis. The disease needs to be diagnosed by combining imaging features, fiberoptic bronchoscopy, and pathological findings.

Usefulness of gastric aspirates for diagnosing nontuberculous mycobacteriosis

Distinguishing between nontuberculous mycobacterial pulmonary disease (NTM-PD) and pulmonary tuberculosis (TB) is difficult. We aimed to evaluate the usefulness of gastric aspirate examination for NTM-PD diagnosis and for differentiating NTM-PD from other diseases, including pulmonary TB. We retrospectively collected data for 491 patients with negative sputum smears or a lack of sputum production at Fukujuji Hospital. We compared 31 patients with NTM-PD to 218 patients with other diseases (excluding 203 with pulmonary TB). Additionally, we compared 81 patients with NTM cultured from at least one sputum or bronchoscopy sample to the other 410 patients. Gastric aspirate examination for NTM-PD diagnosis showed 74.2% sensitivity and 99.0% specificity for culture positivity. There was no significant difference between the nodular bronchiectatic disease and cavitary disease types for culture positivity (p = 0.515). The significance of NTM isolation from gastric aspirate showed 64.2% sensitivity and 99.8% specificity for culture positivity. Gastric aspirate examination revealed NTM in one TB patient, allowing TB to be ruled out in 98.1% of patients with NTM cultured from gastric aspirates. Gastric aspirate examination is helpful for early-stage NTM diagnosis and ruling out pulmonary TB. This could lead to more accurate and timely treatment.

Morphological diagnosis of nontuberculous mycobacteriosis in the surgical material of patients with pulmonary tuberculosis

Objective: to analyze the results of a morphological study of the lung tissue and small airways in the surgical material of patients with a combination of tuberculoma and nontuberculous mycobacteriosis of the lungs caused by different types of pathogen.Materials and methods. A comparative retrospective histological study of the surgical material of 34 patients with a combination of LT and NM with established microbiological different types of non-tuberculous mycobacteria (NTMB) and 36 patients with LT without concomitant pathology was carried out.Results. Diagnostically significant differences in the morphological picture of TL and NM, which manifests its morphological features in areas free from foci of tuberculosis, were revealed. The features of changes in the lung tissue and small airways in patients with slow- and fast-growing types of NTMB are shown.Conclusion. The results obtained are aimed at resolving the issue of possible correction of chemotherapy in the postoperative period.

Efficacy of PBTZ169 and pretomanid against Mycobacterium avium, Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum in BALB/c mice models.

We aimed to evaluate the activity of PBTZ169 and pretomanid against non-tuberculous mycobacteriosis (NTM) in vitro and in vivo. The minimum inhibitory concentrations (MICs) of 11 antibiotics, against slow-growing mycobacteria (SGMs) and rapid-growing mycobacteria (RGMs) were tested using the microplate alamarBlue assay. The in vivo activities of bedaquiline, clofazimine, moxifloxacin, rifabutin, PBTZ169 and pretomanid against four common NTMs were assessed in murine models. PBTZ169 and pretomanid had MICs of >32 μg/mL against most NTM reference and clinical strains. However, PBTZ169 was bactericidal against Mycobacterium abscessus (3.33 and 1.49 log10 CFU reductions in the lungs and spleen, respectively) and Mycobacterium chelonae (2.29 and 2.24 CFU reductions in the lungs and spleen, respectively) in mice, and bacteriostatic against Mycobacterium avium and Mycobacterium fortuitum. Pretomanid dramatically decreased the CFU counts of M. abscessus (3.12 and 2.30 log10 CFU reductions in the lungs and spleen, respectively), whereas it showed moderate inhibition of M. chelonae and M. fortuitum. Bedaquiline, clofazimine, and moxifloxacin showed good activities against four NTMs in vitro and in vivo. Rifabutin did not inhibit M. avium and M. abscessus in mice. PBTZ169 appears to be a candidate for treating four common NTM infections. Pretomanid was more active against M. abscessus, M. chelonae and M. fortuitum than against M. avium.

Клиническое наблюдение микст-инфекции туберкулеза и нетуберкулезного микобактериоза легких

nontuberculous mycobacteriosis is an infectious disease caused by nontuberculous mycobacteria (nTm) with the development of granulomatous inflammation in affected organs and tissues. By now more than 200 nTm species persisting in the environment have been described. According to different authors, 30 to 60 of strains are able to cause disease in humans. It was established that patients with different chronic lung diseases: chronic bronchitis, chronic obstructive pulmonary disease, and bronchiectatic lung disease are predisposed to mycobacteriosis. recently, cases of pulmonary TB/nTm infection have been reported more and more frequently, which impedes timely verification of both diseases. diagnosis of coinfection is essentially facilitated by morphological studies of lung tissue, which can simultaneously assess signs of TB and/or nTm infection. The article describes a clinical case of mixed pulmonary infection with nTm and mycobacterium tuberculosis

Impaired cough-related quality of life in patients with nontuberculous mycobacteriosis.

Cough and sputum are the significant symptoms of nontuberculous mycobacteriosis (NTM) and impair quality of life (QOL). However, the relationship between these symptoms and clinical features is not fully understood. This study aimed to investigate cough-related QOL in NTM patients. The study subjects included 78 patients with NTM at our hospital from October to December 2015. They completed the Leicester Cough Questionnaire (LCQ) and the Cough and Sputum Assessment Questionnaire (CASA-Q) (both questionnaires: the higher, the better); the Frequency Scale for the Symptoms of gastroesophageal reflux disease (GERD) (FSSG), a validated Japanese questionnaire for GERD (the higher, the worse), was also assessed. The FSSG consists of 12 items, including the reflux-related symptoms and dysmotility symptoms domains, each of which is quantified on a scale of 0-4 points, and the cut-off score for GERD is set at 8 points. Associations between these scores and clinical parameters were assessed. The total LCQ score was reduced-the physical domain was dominant. The total LCQ and CASA-Q scores were reduced, with dominance in the physical and symptoms domains, respectively. The reflux-related symptoms score was higher than the dysmotility symptoms score. A multivariate linear regression analysis revealed that the mean total LCQ score was independently associated with current smoking, fibrocavitary type, bilateral cavitary lesion, and FSSG total score. Cough-related QOL was impaired in NTM patients who currently smoked, had radiological characteristics, and had GERD.

Маневры подбора терапии пациентов с нетуберкулезными микобактериозами легких

Aim: To identify the incidence and the characteristics of adverse reactions, to mitigate them, and to determine possible adjustments in antimicrobial therapy. Design: Observational retrospective long-term study. Materials and methods. We examined 125 patients with nontuberculous lung mycobacteriosis. 73.6% of cases had concomitant diseases. Results. The therapy for nontuberculous mycobacteriosis was prescribed in 115 patients, depending on drug susceptibility, and included at least 3 drug products. 31.3% of patients had adverse reactions; one third of these patients had allergic reactions. Hepatotoxic reactions were recorded in 16.5% of cases, cardiotoxic — in 12.2%, ototoxic — in 10.4%, optic neuritis was diagnosed in 5 % of cases. In 31.3% of cases, the therapy was adjusted, in 13.9% of cases, the therapy was reviewed and alternative treatment was offered. The complete antibacterial course was prescribed to 79 (68.7%) patients. Conclusion. The therapy for nontuberculous mycobacteriosis should be selected in inpatient settings with laboratory and functional monitoring. Keywords: nontuberculous lung mycobacteriosis, antimicrobial therapy, adverse reactions.

ЗНАЧЕНИЕ КОМПЬЮТЕРНО-ТОМОГРАФИЧЕСКОГО ИССЛЕДОВАНИЯ ПРИ ВЫПОЛНЕНИИ НАВИГАЦИОННЫХ БРОНХОБИОПСИЙ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ ПЕРИФЕРИЧЕСКИХ ОБРАЗОВАНИЙ ЛЕГКИХ

Aim: to study radiological semiotics of peripheral pulmonary lesions (PPLs) detected by CT of the chest, and establish radiological patterns, which significantly increase effectiveness of navigation bronchobiopsies. Materials and methods. A cohort retrospective study included 278 patients with PPLs with verified diagnoses established by invasive diagnostic procedures (navigation bronchoscopy with a complex of biopsies and/or diagnostic thoracic surgery). The study included 162 (58.3%) women aged 13 to 80 yrs. (average age – 46.21 ± 5.23) and 116 (41.7%) men aged 14 to 85 yrs. (average age – 46.05 ± 3.49). The patients were divided into 4 nosological groups: pulmonary TB patients – 158 (56.8%), neoplastic patients – 79 (28.4%), nontuberculous pulmonary mycobacteriosis (NTPM) patients – 21 (7.6%), and protracted course community-acquired pneumonia (CAP) patients (presentations of PPLs) – 20 (7.2%). Results. According to chest CT data, PPLs had three major radiological sings, defined as “infiltrate”, “rounded shadow”, and “focus”. Rounded shadows prevailed in NTPM patients and neoplastic patients. Statistically significant differences between the groups were as follows: the medium maximum size and contour of PPLs (focus / rounded shadow / infiltrate), the presence of bronchiectasis and the type of foci (lobular/sublobular/acinar) in the lung parenchyma surrounding PPLs, the presence of calcification, cavitation, or air bronchograms inside PPLs. The total effectiveness of bronchoscopic verification of PPLs in patients with “CT bronchus sign” was 79.4%, which significantly exceeded diagnosis verification in patients without it (17.9%) (р &lt; 0.001). The effectiveness of diagnosis verification by bronchobiopsy in patients with PPLs less than 20 mm (CT data) achieved 50% irrespective of etiology. The most effective bronchoscopic verification of diagnoses was observed in TB and NTPM patients with PPLs ≥ 20 mm – 83.3% and 100.0% respectively, and in neoplastic patients with PPLs ≥ 30 mm it reached 93.0%. The lobar localization of the process did not affect the diagnostic effectiveness of bronchobiopsies. Conclusion. The highest effectiveness of bronchobiopsies was observed in patients with the CT bronchus sign and with PPLs ≥ 20 mm or ≥ 30 mm (CT data). The volume of diagnostic biopsies obtained by navigation bronchoscopy or surgical resection should be determined by radiological morphology of PPLs with estimation of malignancy or benign signs revealed by CT of the chest.

СТРАТЕГИЯ ЛЕЧЕНИЯ МИКОБАКТЕРИОЗА ЛЕГКИХ: ПРОБЛЕМА ЛЕКАРСТВЕННОЙ РЕЗИСТЕНТНОСТИ

The pulmonary disease caused by nontuberculous mycobacteria (NTM) is a chronic respiratory infection resulting in declining lung function, worsening life quality, and increasing mortality rates. Most patients with pulmonary nontuberculous mycobacteriosis (PNTM) have concomitant chronic diseases (bronchiectatic disease, COPD, diabetes mellitus, etc.) PNTM is a refractory disease as mycobacteria are located intracellularly in alveolar macrophages. Mycobacteria can develop a biofilm, which impedes antibiotic penetration and protects them. Treatment for PNTM is long-term with low effectiveness due to innate or acquired mycobacterial resistance. The article outlines the modern concepts of drug resistance development in NTM, refractoriness of the disease, and the current mechanisms to overcome it.

Prevalence of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization.

To identify the prevalence of non-bronchial systemic culprit arteries and their relationship to bleeding lobes in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization (BAE). Data of 83 consecutive patients with bronchiectasis and chronic pulmonary infection (non-tuberculous mycobacteriosis, aspergillosis, and tuberculosis) who underwent de novo BAE between January 2019 and December 2020 were retrospectively reviewed. The prevalence of culprit arteries was investigated. Fifty-five patients (66%) had 172 non-bronchial systemic culprit arteries. The bleeding lobes were the right upper, right middle, right lower, left upper, and left lower lobes in 14 (17%), 20 (24%), 7 (8%), 31 (37%), and 11 (13%) patients, respectively. The internal thoracic (49%; n = 41), intercostal (28%; n = 23), and inferior phrenic (28%; n = 23) arteries were the top three non-bronchial systemic culprit arteries, which were involved in all five types of bleeding lobes. The costocervical trunk and thoracoacromial and lateral thoracic arteries were predominant in patients with upper lobe bleeding. Ligament arteries were predominant in patients with left lower lobe bleeding. These findings will better ensure the identification of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection. All systemic arteries, especially those which are adjacent to the lung lesions, should be evaluated carefully using MDCT; the internal thoracic, intercostal, and inferior phrenic arteries should be proactively assessed using angiography. • Non-bronchial systemic culprit arteries were identified in 66% of patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization. • The internal thoracic (49%), intercostal (28%), and inferior phrenic (28%) arteries were the top three arteries, which were involved in all five types of bleeding lobes. • The costocervical trunk and thoracoacromial and lateral thoracic arteries were prominent in patients with upper lobe bleeding, and the ligament artery was prominent in patients with left lower lobe bleeding.

Epidemiological characteristics of nontuberculous mycobacteriosis and bronchiectasis: comparative study using national mortality statistics from 1970 to 2015 in Japan.

This study assessed longitudinal national data on mortality due to nontuberculous mycobacteriosis (NTMosis) and bronchiectasis and the association between the two diseases. We analysed the national death statistics of Japan from 1970 to 2015. The International Classification of Disease (ICD) codes were used to extract the relevant data. Crude mortality, age-adjusted mortality and standardised mortality rates were calculated using vital statistics and the population in 2000. We also identified domestic publications related to NTMosis and bronchiectasis with an internet-based search system. The total number of bronchiectasis-related deaths remained at the same level, which was approximately 1000, for 45 years, although the number of deaths has consistently decreased in males but increased in females since the mid-1990s. A substantial increasing trend in females was also observed for NTMosis in the same period. The age-adjusted mortality data showed an increase in mortality in women due to NTMosis and confirmed the trend in bronchiectasis in women. The patterns in the number of domestic reports showed a recent slight increase in bronchiectasis and a marked increase in NTMosis. The trends in bronchiectasis-related mortality differed by sex. The epidemiological trends in the two diseases were associated, especially in elderly females since the mid-1990s. It is suggested that pulmonary NTMosis without pre-existing bronchiectasis might be a leading cause of postinfectious bronchiectasis in Japan.

Usefulness of gastric aspirate for the diagnosis of smear-negative pulmonary tuberculosis

IntroductionGastric aspirate can be useful for the diagnosis of pulmonary tuberculosis (TB) in patients with smear-negative pulmonary TB or without sputum production. The gastric aspirate smear technique has low sensitivity, and a previous report demonstrated that no patient was diagnosed by only gastric aspirate analysis. However, some patients with TB have been negative on sputum examination but positive on gastric aspirate examination, and the incidence of such cases is uncertain. Therefore, this study investigated the usefulness of gastric aspirate in the diagnosis of pulmonary TB. MethodsTo analyze the diagnostic accuracy of gastric aspirate examination, the data of 513 patients with negative sputum smears or a lack of sputum production, including 203 patients with pulmonary TB (39.6%) and 93 patients with nontuberculous mycobacteriosis who underwent gastric aspiration at Fukujuji Hospital from January 2016 to March 2021, were collected retrospectively. ResultsThe accuracy rates of gastric aspirate examination for the diagnosis of pulmonary TB were as follows: 21.2% sensitivity and 91.9% specificity for smear positivity, 55.8% sensitivity and 99.6% specificity for nucleic acid amplification test positivity, and 71.4% sensitivity and 100% specificity for culture positivity. Twenty-three patients (11.2%) were diagnosed by gastric aspirate examination alone. Among the 356 patients who underwent three repeated sputum examinations in addition to gastric aspirate examination, the cumulative diagnostic rate for the 3 mycobacterial examinations plus gastric aspirate examination was higher than that for only three sputum examinations. ConclusionsGastric aspirate is useful for the diagnosis of TB in patients with smear-negative pulmonary TB or without sputum production.

Epidemiologic evaluation of pleurisy diagnosed by surgical pleural biopsy using data from a nationwide administrative database.

BackgroundPleural biopsies for investigating the causes of pleurisy are performed through modalities including needle biopsies, local anesthetic thoracoscopic procedures, and surgery (video‐assisted thoracoscopic surgery and open thoracotomy). To date, there have been no large‐scale nationwide epidemiological studies regarding pleurisy diagnosed via surgical pleural biopsy. This study examined the epidemiology of pleurisy diagnosed via surgical pleural biopsy in a Japanese nationwide administrative database.MethodsWe evaluated Japanese Diagnosis Procedure Combination data of 24 173 patients who underwent video‐assisted thoracoscopic surgery or open thoracotomy and received a diagnosis of pleurisy between April 2014 and March 2020. In addition to pleurisy diagnoses, the patients' clinical information, including age, sex, smoking status (pack‐years), dyspnea grade, length of in‐hospital stay, and comorbidities, were extracted from the dataset.ResultsThis study included data from 1699 patients. The most frequent causes of pleurisy were neoplastic diseases (55.9%; malignant mesothelioma 22.5%, lung cancer 15.7%, lymphoma 2.5%), followed by infectious diseases (24.0%; tuberculosis 16.2%, parapneumonic pleural effusion 3.6%, empyema 3.5%, nontuberculous mycobacteriosis 0.5%), collagen vascular diseases (2.8%; rheumatoid arthritis 1.3%, immunoglobulin G4‐related diseases 0.7%, systemic lupus erythematosus 0.3%), and paragonimiasis (0.1%).ConclusionsNeoplastic diseases, including malignant mesothelioma and lung cancer, were frequently and accurately diagnosed as pleurisy via surgical pleural biopsy. The next leading cause was infectious diseases such as mycobacterial infections. Physicians should consider performing surgical biopsy in light of the knowledge regarding the etiology of pleurisy when a definitive diagnosis cannot be made via needle pleural biopsy.