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Mycobacterium xenopi pulmonary infections: A multicentric retrospective study of 136 cases in North East France. Clinical and radiological features, treatment and outcome
  1. Claire Andrejak (claire_ski2002{at}yahoo.fr)
  1. Teaching Hospital Amiens, France
    1. Francois-Xavier Lescure (xavier.lescure{at}tnn.aphp.fr)
    1. Infectious Disease Unit Tenon Hospital APHP, France
      1. Evelina Pukenyte (evelina_pukenyte{at}yahoo.com)
      1. Infectious Disease Unit Tourcoing Hospital, France
        1. Youcef Douadi (ydou{at}club-internet.fr)
        1. Infectious Disease Unit Amiens Hospital, France
          1. Yazdan Yazdanpanah (yyazdan{at}yahoo.com)
          1. Infectious Disease Unit Tourcoing Hospital, France
            1. Genevieve Laurans (laurans.genevieve{at}chu-amiens.fr)
            1. Bacteriology Unit Teaching Hospital Amiens, France
              1. Jean-Luc Schimit (schmit.jean-luc{at}chu-amiens.fr)
              1. Infectious Diseases Unit Teaching Hospital Amiens, France
                1. Vincent Jounieaux (jounieaux.vincent{at}chu-amiens.fr)
                1. Centre Hospitalier Universitaire Sud, France

                  Abstract

                  Background: Due to its low incidence, the management of Mycobacterium xenopi pulmonary infections is not clearly defined.

                  Methods: The objectives of this multicentre retrospective study were to describe the features of the disease and to evaluate its prognosis. All patients with M.xenopi satisfying the 1997 ATS/IDSA criteria were included from 13 hospitals of North East France (1983-2003). Clinical, radiological and bacteriological characteristics, management and outcome were collected.

                  Results: One hundred and thirty six patients were included. Only 12 patients presented no comorbidity. Three features could be distinguished: the classical cavitary form (n=39, 31%) occurred in patients with pre-existent pulmonary disease; the solitary nodular form (n=41, 33%) in immunocompetent patients and the acute infiltrate form (n=45, 36%) in immunosupressed patients. Fifty six patients did not receive any treatment. The other 80 patients received first-line treatment containing rifamycin (87.5%), ethambutol (75%), isoniazid (66.2%), clarithromycin (30%) or fluoroquinolones (21%). After a follow-up of 36 months, 80 patients (69.1%) were dead and the median survival was 16 months [10-22]. Two independent prognostic factors were found: the acute infiltrate form associated with a bad prognosis (HR 2.6 p=0.001) and a protective factor the rifamycin-containing regimen (HR 0.325 p=0.006). Clarithromycin-containing regimen did not improve the prognosis.

                  Conclusions: In contrast of recent guidelines, our study showed three different features of the disease (cavitary, nodular or diffuse infiltrate form) with different prognosis. In order to improve the survival, all patients with M.xenopi infection must be treated with a rifamycin-containing regimen. The usefulness of clarithromycin remains to be evaluated.

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