Clinico-microbiological analysis of 121 patients with pulmonary Mycobacteroides abscessus complex disease in Japan – An NTM-JRC study with RIT

Abstract

Rationale: No comprehensive analysis has previously been performed to evaluate the clinical aspects of and microbiological evidence associated with Mycobacteroides abscessus complex (MABC) infection in a region, such as Japan, with a low MABC incidence. Objectives: This study aimed to clarify the clinicopathological characteristics of MABC, which included clinical relatedness to erm(41) sequevar, phenotype (as colony morphology and minimum inhibitory concentration), and genotype. Methods: A total of 121 MABC patients (68 with M. abscessus subsp. abscessus and 53 with M. abscessus subsp. massiliense) were recruited into this retrospective clinical-biological study from tertiary hospitals in Japan between 2004 and 2014. Results: Approximately 30% of MABC patients had a history of previous nontuberculous mycobacterium (NTM) disease. Furthermore, 24.8% of the patients had another concomitant NTM infection after they were diagnosed with MABC. Fewer than 10% of the patients in the M. abscessus group had T28C in erm(41). While we observed a higher conversion rate for M. massiliense than for M. abscessus (72.4% and 34.8%, respectively, p = 0.002), recurrence remained relatively common for M. massiliense (31.0%). In the M. abscessus patients, the MIC of clarithromycin (CLR) was significantly lower on day 3 in patients with a better treatment response than in refractory patients (The median MIC; 0.75 μg/ml v.s 2.0 μg/ml, p = 0.03). There was no significant relation between clinical manifestations and variable number of tandem repeat genotypes. Conclusions: Because the history and simultaneous isolation of other NTM in MABC infection are relatively common, these information should be carefully translated into clinical actions. The evaluation of early CLR resistance in M. abscessus and the erm(41) functions should be important to improve the treatment strategy.

Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan

“…The number of incident MABC-PD cases has recently increased consistent with the nationwide survey data, and exceeded that of MK-PD cases. The proportions of M. abscessus and M. massiliense in this study were 57% and 43%, respectively; the proportions were similar to those found in other reports from Japan [15,19,20]. Similar to the report of the national surveillance, the mean age of pulmonary TB cases increased during the study period [8].…”

Identification and Characteristics of Co-isolation of Multiple Nontuberculous Mycobacteria

“…Multiple NTM species isolates are not rare. A previous report on M. abscessus complex (MABC) disease showed that approximately 25% of the patients had multiple NTM species, and 80% of them met the microbiological diagnostic criteria for non-MABC NTM disease (16). Our results showed some clinical characteristics for patients with multiple NTM species and several species-dependent characteristics in the patterns of co-isolation.…”

Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: a 15-year follow-up study

“…For example, M. intracellulare disease had a more severe clinical presentation and poorer treatment outcomes when compared with M. avium disease in one study [36]. Additionally, compared with M. abscessus disease, M. massiliense disease responds more favourably to macrolide-containing antibiotic therapy [18,37,38]. In this context, our data clearly showed that the accurate identification of the species or subspecies of the aetiological NTM organism is very important in the prognosis of NTM-PD.…”