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Nontuberculous Mycobacteria

II: Nested-Cohort Study of Impact on Cystic Fibrosis Lung Disease

The Cystic Fibrosis/Pulmonary Research and Treatment Center, Departments of Epidemiology, Biostatistics, and Radiology, and the Verne S. Caviness General Clinical Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Pulmonary/Critical Care Medicine Flight, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas; Department of Pathology, Case Western Reserve University, Cleveland, Ohio

Correspondence and requests for reprints should be addressed to Lt. Col. Kenneth N. Olivier, M.D., M.P.H., U.S.A.F., M.C., Wilford Hall, United States Air Force Medical Center, MSGS/MCCP (Pulmonary/Critical Care), 2200 Bergquist Drive, Ste 1, Lackland AFB, TX 78236-5300. E-mail: kenneth.olivier{at}lackland.af.mil

The prevalence of nontuberculous mycobacteria (NTM) is high (approximately 13%) in sputum of patients with cystic fibrosis (CF), but the impact on lung disease is unknown. We followed 60 incident NTM-positive and 99 culture-negative patients with CF for 15 months and assessed clinical impact of NTM by FEV₁ and high-resolution computed tomography (HRCT) of the chest. Mycobacterium avium complex was seen in 75% of NTM-positive subjects. The annual rate of decline in FEV₁ was not different among control versus NTM-positive subjects who did not, or did, meet American Thoracic Society microbiologic criteria for NTM disease (3 ± 1, 3 ± 2, and 5 ± 2%, respectively). More subjects with three or more positive cultures for NTM had two or more characteristic findings on entry HRCT (60%, 9/15) as compared with subjects with two positive cultures or less (32%) or negative cultures (19%; p < 0.02). All subjects with three or more positive cultures and exit HRCTs (n = 6) showed progression of HRCT findings, whereas only 17% of subjects with two positive cultures or less had progression (p = 0.0006). In summary, no significant short-term effect on FEV₁ was detected in patients with multiple positive NTM cultures, but an abnormal HRCT was predictive of progression. Patients with CF and multiple positive NTM cultures, characteristic HRCT findings, and progression of HRCT changes should be monitored closely and considered for antimycobacterial therapy.

Key Words: cystic fibrosis • nontuberculous mycobacteria • Mycobacterium avium-intracellulare • Mycobacterium abscessus • computed tomography of chest

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