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. 2017 Dec 20;17(1):213.
doi: 10.1186/s12890-017-0539-7.

Implication of species change of Nontuberculous Mycobacteria during or after treatment

Jong Sik Lee  1 , Jong Hyuk Lee  2 , Soon Ho Yoon  2 , Taek Soo Kim  3 , Moon-Woo Seong  3 , Sung Koo Han  1 , Jae-Joon Yim  4
Affiliations

Implication of species change of Nontuberculous Mycobacteria during or after treatment

Jong Sik Lee et al. BMC Pulm Med. .

Abstract

Background: Co-existence or subsequent isolation of multiple nontuberculous mycobacteria (NTM) species in same patient has been reported. However, clinical significance of these observations is unclear. The aim of this study was to determine clinical implications of changes of NTM species during or after treatment in patients with NTM lung disease.

Methods: Patients with NTM lung disease, who experienced changes of NTM species during treatment or within 2 years of treatment completion between January 1, 2009 and December 31, 2015, were included in the analysis. Demographic, clinical, microbiological, and radiographic data were reviewed and analyzed.

Results: During the study period, 473 patients were newly diagnosed with NTM lung disease. Treatment was started in 164 patients (34.6%). Among these 164 patients, 16 experienced changes of NTM species during or within 2 years of treatment completion. Seven showed changes from M. avium complex (MAC) to M. abscessus subspecies abscessus (MAA) and five patients displayed changes from M. abscessus subspecies massiliense (MAM) to MAC. With isolation of new NTM species, 6 out of 7 patients with change from MAC to MAA reported worsening of symptoms, whereas none of the five patients with change from MAM to MAC reported worsening of symptoms. All MAA isolated during or after treatment for MAC lung diseases showed inducible resistance to clarithromycin.

Conclusions: Change of NTM species may occur during or after treatment for NTM lung disease. Especially, changes from MAC to MAA is accompanied by symptomatic and radiographic worsening as well as inducible resistance to clarithromycin.

Keywords: Clarithromcycin resistance; Mycobacterium abscessus subspecies abscessus; Mycobacterium avium Complex; Nontuberculous mycobacteria species change.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board of Seoul National University Hospital (IRB No: 1608-046-784) and was conducted in accordance with the amended Declaration of Helsinki. All participants provided written informed consent before enrollment.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Chest CT scan of a patient with symptomatic Mycobacterium intracellulare lung disease before initiation of treatment. The scan shows bronchiectasis, nodules, and reticular densities in the right middle lobe and lingular segment. Treatment started 4 weeks after checking this CT scan. b Chest CT scan at 6 months after the initiation of treatment showing substantial improvement. c Chest CT scan at 12 months after the completion of 18-month treatment for M. intracellulare lung disease. Radiographic lesions and symptoms worsened; bloody sputum was also noted. Four weeks after this CT scan was taken, M. abscessus subspecies abscessus, instead of M. intracellulare, was isolated. d Chest CT scan at 6 months after initial isolation of M. abscessus subspecies abscessus. The patient’s symptoms continued to worsen and sputum persistently tested positive for M. abscessus subspecies abscessus
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