Am. J. Respir. Crit. Care Med., Volume 160, Number 6, December 1999, 1851-1855

Markers Indicating Deterioration of Pulmonary Mycobacterium avium-intracellulare Infection

YOSHITAKA YAMAZAKI, KEISHI KUBO, AKEMI TAKAMIZAWA, HIROSHI YAMAMOTO, TAKAYUKI HONDA, and SHUSUKE SONE

Departments of Medicine, Laboratory Medicine and Radiology, Shinshu University, School of Medicine, Matsumoto, Japan

To predict the natural history of pulmonary Mycobacterium avium-intracellulare (MAI) infection with nodular bronchiectasis, we retrospectively evaluated clinical manifestations, laboratory data, and bronchoalveolar lavage fluid (BALF) findings in 57 patients. The patients received follow-up chest computed tomographic scans and testing for sputum bacteriology between intervals of at least 12 mo. They were divided into two groups after observation for 28 ± 13 mo: deteriorated (n = 34) and not-deteriorated (n = 23). There were no patients with spontaneous improvement. At the start of observation, the mean age was greater in the deteriorated group (69 ± 9 yr) than in the not-deteriorated group (57 ± 9 yr). The mean body-mass index was lower in the deteriorated group (19.2 ± 3.1 kg/m²) than in the not-deteriorated group (21.5 ± 1.5 kg/m²). C-reactive protein, erythrocyte sedimentation rate, and carbohydrate antigen 19-9 were significantly elevated in the deteriorated group. The BALF findings of the deteriorated group showed that the neutrophil cell counts were significantly increased. Thirty-four of 57 patients with pulmonary MAI infection with nodular bronchiectasis had progressive clinical and/or radiographic disease. The older and thinner patients tended to become worse. Neutrophil-related inflammation associated with a decrease in CD4+ lymphocyte might reflect the progression of pulmonary MAI infection with nodular bronchiectasis. Yamazaki Y, Kubo K, Takamizawa A, Yamamoto H, Honda T, Sone S. Markers indicating deterioration of pulmonary Mycobacterium avium-intracellulare infection.

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