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Published ahead of print on November 14, 2002, doi:10.1164/rccm.200207-679OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 6, March 2003, 835-840

A more recent version of this article appeared on March 15, 2003
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Submitted on July 9, 2002
Accepted on November 6, 2002

Nontuberculous Mycobacteria: II. Nested cohort study of impact on cystic fibrosis lung disease

Kenneth N Olivier1*, David J Weber2, Ji-Hyun Lee3, Allison Handler4, Gail Tudor3, Paul L Molina5, Joseph Tomashefski6, and Michael R Knowles4

1 Pulmonary/Critical Care Medicine Flight, Wilford Hall USAF Medical Center, Lackland AFB, TX, USA; Cystic Fibrosis/Pulmonary Research and Treatment Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Verne S. Caviness General Clinical Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Verne S. Caviness General Clinical Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Cystic Fibrosis/Pulmonary Research and Treatment Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 6 Department of Pathology, Case Western Reserve University, Cleveland, OH, USA

* To whom correspondence should be addressed. E-mail: kenneth.olivier{at}lackland.af.mil.

The prevalence of nontuberculous mycobacteria (NTM) is high (~13% ) in sputum of CF patients, but the impact on lung disease is unknown. We followed 60 incident NTM-positive and 99 culture-negative CF patients for 15 months, and assessed clinical impact of NTM by FEV1 and chest HRCT. M. 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 ATS microbiologic criteria for NTM disease (3±1; 3±2; and 5±2%, respectively). More subjects with >=3 positive cultures for NTM had >=2 characteristic findings on entry HRCT (60%; 9/15), as compared to subjects with <=2 positive cultures (32%) or negative cultures (19%; p<0.02). All subjects with >=3 positive cultures and exit HRCTs (n=6) showed progression of HRCT findings, whereas only 17% of subjects with <=2 positive cultures 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. CF patients with 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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