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Case Reports
. 2015 May;147(5):1369-1375.
doi: 10.1378/chest.14-1297.

The significance of Mycobacterium abscessus subspecies abscessus isolation during Mycobacterium avium complex lung disease therapy

David E Griffith  1 , Julie V Philley  2 , Barbara A Brown-Elliott  3 , Jeana L Benwill  2 , Sara Shepherd  3 , Deanna York  3 , Richard J Wallace Jr  4
Affiliations
Case Reports

The significance of Mycobacterium abscessus subspecies abscessus isolation during Mycobacterium avium complex lung disease therapy

David E Griffith et al. Chest. 2015 May.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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Figures

Figure 1 –
Figure 1 –
A, Chest CT scan cut from 78-y-old woman with symptomatic Mycobacterium avium complex lung disease prior to initiation of therapy. Scan shows bilateral nodular and reticulonodular densities on the left greater than the right. B, Chest CT scan cut at a comparable level to A after 12 mo of M avium complex therapy, including 6 mo of negative sputum cultures for M avium complex, showing improvement in bilateral nodular and reticulonodular densities. C, Chest CT scan cut at comparable level to A and B 18 mo after starting M avium complex therapy with 12 mo of negative sputum cultures for M avium complex but with sputum consistently culture positive for M abscessus subspecies abscessus.
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References

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