Chest
Volume 142, Issue 6, December 2012, Pages 1482-1488
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Original Research
Chest Infections
Clinical Significance of the Differentiation Between Mycobacterium avium and Mycobacterium intracellulare in M avium Complex Lung Disease

https://doi.org/10.1378/chest.12-0494Get rights and content

Background

Mycobacterium avium and Mycobacterium intracellulare are grouped together as the M avium complex; however, little is known about the clinical impact of this species differentiation. This study compared the clinical features and prognoses of patients with M avium and M intracellulare lung disease.

Methods

From 2000 to 2009, 590 patients were given a new diagnosis of M avium complex lung disease; 323 (55%) had M avium lung disease, and 267 (45%) had M intracellulare lung disease.

Results

Compared with the patients with M avium lung disease, the patients with M intracellulare lung disease were more likely to have the following characteristics: older age (64 vs 59 years, P = .002), a lower BMI (19.5 kg/m2 vs 20.6 kg/m2, P < .001), respiratory symptoms such as cough (84% vs 74%, P = .005), a history of previous treatment for TB (51% vs 31%, P < .001), the fibrocavitary form of the disease (26% vs 13%, P < .001), smear-positive sputum (56% vs 38%, P < .001), antibiotic therapy during the 24 months of follow-up (58% vs 42%, P < .001), and an unfavorable microbiologic response after combination antibiotic treatment (56% vs 74%, P = .001).

Conclusions

Patients with M intracellulare lung disease exhibited a more severe presentation and had a worse prognosis than patients with M avium lung disease in terms of disease progression and treatment response. Therefore, species differentiation between M avium and M intracellulare may have prognostic and therapeutic implications.

Section snippets

Study Population

Consecutive patients with MAC lung disease who were given the diagnosis between January 2000 and December 2009 were identified using the database of the NTM Registry of Samsung Medical Center (a 1,950-bed referral hospital in Seoul, South Korea).12, 15 The data from January 2008 to December 2009 are being used in an ongoing prospective observational cohort study to investigate NTM lung disease.16 This study protocol was approved by the institutional review board of the Samsung Medical Center

Clinical Features of MAC Lung Disease

During the 10-year period, 590 patients with MAC lung disease were identified. The etiologic organisms included M avium in 323 patients (55%) and M intracellulare in 267 (45%). Other MAC member species, such as Mycobacterium colombiense, were not found during the study period. All patients were HIV negative.

As shown in Table 1, patients with M intracellulare lung disease typically were older than patients with M avium lung disease (64 years vs 59 years, P = .002) and more likely to have a

Discussion

This study examined > 500 patients with MAC lung disease and focused primarily on the clinical relevance of species differentiation between M avium and M intracellulare. In the present cohort of patients with MAC without HIV infection, M avium and M intracellulare differed in the clinical features, disease progression, and treatment response to antibiotic therapy. Patients with M intracellulare lung disease exhibited a more severe and advanced clinical presentation at the time of diagnosis,

Acknowledgments

Author contributions: Drs Koh and Jeong had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Koh: contributed to the study design, data acquisition and interpretation, study supervision, and writing of the manuscript.

Dr Jeong: contributed to the study design, data acquisition and interpretation, and writing of the manuscript.

Dr Jeon: contributed to the data acquisition and interpretation and critical

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      Citation Excerpt :

      M. avium and M. intracellulare cannot be differentiated through conventional microbiological tests and their clinical features are often considered indistinguishable [1]. However, a study in Korea found that patients with M. intracellulare lung disease exhibited a more severe illnesses and worse prognosis than patients with M. avium lung disease [30]. A previous study using an animal model also suggested that M. intracellulare was the more virulent species [31].

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

    Drs Koh and Jeong contributed equally to this work.

    Funding/Support: This work was supported by the Mid-Career Researcher Program through a National Research Foundation grant funded by the Ministry of Education, Science and Technology [grants 2011-0015546] in South Korea.

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