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Observational Study
. 2019 May 24;19(1):468.
doi: 10.1186/s12879-019-4078-0.

Nontuberculous mycobacterial pulmonary disease diagnosed by two methods: a prospective cohort study

Hyung-Jun Kim  1 , Jong Hyuk Lee  2 , Soon Ho Yoon  2 , Sung A Kim  1 , Myoung Sil Kim  1 , Sun Mi Choi  1 , Jinwoo Lee  1 , Chang-Hoon Lee  1 , Sung Koo Han  1 , Jae-Joon Yim  3
Affiliations
Observational Study

Nontuberculous mycobacterial pulmonary disease diagnosed by two methods: a prospective cohort study

Hyung-Jun Kim et al. BMC Infect Dis. .

Abstract

Background: Microbiological criteria for diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD) include positive culture results from at least two separately expectorated sputum specimens or one bronchial washing or lavage. However, the clinical similarities and differences between patients diagnosed by these two methods remain unclear. We compared clinical features and prognoses of patients with NTM-PD diagnosed from both specimen types.

Methods: We analysed data from patients who participated in the Seoul National University Hospital NTM-PD cohort ( ClinicalTrials.gov identifier: NCT01616745). Baseline demographics, symptoms, radiographic findings, disease progression, and treatment responses were summarized and compared between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimens.

Results: Three hundred forty-seven patients were included in the analyses. Of these, 279 (80.4%) were diagnosed from two separately expectorated sputum specimens, and 68 (19.6%) were diagnosed from bronchoscopic specimens. Patients diagnosed from sputum specimens had more frequent and severe cough, sputum, postnasal drip, and high St. George's Respiratory Questionnaire scores. However, the extent and severity of the radiographic lesions, disease progression, and treatment responses were similar for both groups. Further analysis based on the following three groups (sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy groups) suggested that the scanty sputum/bronchoscopy group appeared to have the worst prognosis in terms of both time to progression and time to culture conversion.

Conclusions: Although some symptoms and quality of life were worse in patients with NTM-PD diagnosed from sputum specimens, their prognoses were similar to those of patients diagnosed by bronchoscopic specimen. We recommend bronchoscopic sampling for patients in whom NTM-PD is suspected clinically or radiographically, especially those who have no or scanty sputum.

Keywords: Clinical medicine; Cohort studies; Diagnosis; Nontuberculous mycobacteria; Progression.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of disease progression and time to culture conversion between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimen. a Probability of progression-free survival. b Probability of culture conversion after treatment
Fig. 2
Fig. 2
Comparison of disease progression and time to culture conversion according to three groups: sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy group. a Probability of progression-free survival. b Probability of culture conversion after treatment
See this image and copyright information in PMC

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