Etiology, Clinical, Radiological, and Microbiological Profile of Patients with Non-cystic Fibrosis Bronchiectasis at a Tertiary Care Hospital of Pakistan

Sharif, Nadia; Baig, Mirza Saifullah; Sharif, Sana; Irfan, Muhammad

doi:10.7759/cureus.7208

Cited by 7 publications

(21 citation statements)

References 26 publications

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“…Indian study reported 50% (7,8). This is higher than other areas of the world, even in Asia (Saudi Arabia 43%, Korea 20%) (5,6).…”

Section: Discussionmentioning

confidence: 81%

“…TB is known to be the most common cause of Bronchiectasis in South Asia (7,19) and patients with Post TB Bronchiectasis are known to have more severe disease compared with Non-TB Bronchiectasis (5,20–23). However, there has been little research into its prevalence, microbiology, or complications in Pakistan(8,18). In this single-centre retrospective cohort study at Bach Christian Hospital (BCH) in rural Northern Pakistan, we seek to explore the frequency of TB as a cause of Bronchiectasis, demographics, as well as the microbiology and associated complications in TB versus Non-TB Bronchiectasis.…”

Section: Introductionmentioning

confidence: 99%

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Post Tuberculosis (TB) Bronchiectasis versus Non-TB Bronchiectasis in Northern Pakistan: A single centre retrospective cohort study on frequency, demographics, microbiology, and complications

Hoole,

Ilyas,

Munawar

et al. 2024

Preprint

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IntroductionWhile Post Tuberculous (TB) Bronchiectasis is the most common cause of Bronchiectasis in South Asia, there has been little research into its microbiology and clinical characteristics in Pakistan. This single centre retrospective cohort study at Bach Christian Hospital (BCH) in rural Northern Pakistan seeks to address this issue.MethodsDemographic, Imaging, Aetiological and Microbiological data were obtained from 32 patients with Bronchiectasis at BCH from between January 2023 and December 2023(1–3).Results76% (25/32) of all cases of Bronchiectasis were Post TB. TB infection was seen in 5 cases of Post TB Bronchiectasis, TB with bacterial or fungal co infections in 4, and single bacterial infections in 4. In post TB Bronchiectasis 4 patients had growth of a single bacterium. Drug sensitivities were obtained for bacterial isolates.One patient each with Post TB and Non-TB Bronchiectasis died from Type 2 Respiratory failure despite appropriate treatment. 2 patients with Post TB Bronchiectasis and destroyed lung syndrome improved but with ongoing significant respiratory impairment(4). All other patients improved with treatment.DiscussionThe frequency of Post TB Bronchiectasis is very high even for South Asia(5–8).A significant number (8/24) of Post TB Bronchiectasis had re-infection or failure to improve despite appropriate drug treatment. TB PCR (Polymerase Chain Reaction) on Bronchoalveolar lavage (BAL) was key in the management of these patients(9).Among patients with Post TB Bronchiectasis, those with co-infection present a difficult treatment challenge.Some patients with Post TB Bronchiectasis have significant complications such as destroyed lung syndrome which is difficult to manage.Drug susceptible bacteria and NTM were less commonly isolated than in other studies(10–12).ConclusionFurther research is needed particularly to manage Post TB Bronchiectasis patients with co-infections or complications such as significant structural lung disease.Key MessagesWhat is known about this topicTuberculosis (TB) is the most common cause of bronchiectasis in South Asia, but little is known about microbiology or clinical characteristics of post-TB Bronchiectasis.What this study addsPost TB Bronchiectasis has a very high prevalence in our region, with TB PCR key for diagnosis of TB re-infection in some cases. Mycobacterial, Bacterial and Fungal co-infections form a treatment challenge, as does significant structural lung disease such as destroyed lung.How this study might affect research, practice, or policyTB PCR testing is a valuable tool in Post TB Bronchiectasis and further research and larger-scale studies are needed to determine optimal treatment for co-infections and significant structural lung disease.

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“…Indian study reported 50% (7,8). This is higher than other areas of the world, even in Asia (Saudi Arabia 43%, Korea 20%) (5,6).…”

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Post Tuberculosis (TB) Bronchiectasis versus Non-TB Bronchiectasis in Northern Pakistan: A single centre retrospective cohort study on frequency, demographics, microbiology, and complications

Hoole,

Ilyas,

Munawar

et al. 2024

Preprint

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“…Our review presented a slightly lower prevalence of NTM isolation in bronchiectasis than the previous systematic review that reported an overall prevalence of 9.3% in 8 studies [12]. Since publication of this systematic review, 16 new relevant studies have been published [5, 7, 8, 17‒26, 28‒30, 35]. It is also worth noting that we only included studies written in English and using objective and valid methods to validate bronchiectasis and NTM isolation rather than self-reported or medical record review, given the low sensitivity of diagnosis code-based claims to identify NTM.…”

Section: Discussionmentioning

confidence: 96%

“…Upon further review, 1,490 abstracts or articles were rejected for not meeting inclusion criteria or meeting exclusion criteria. Of the 34 full-text articles reviewed, 21 articles, which reported the prevalence of NTM isolation or NTM-PD were included [5,7,8,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. No additional articles were identified from manually reviewing the reference lists of included articles.…”

Section: Study Attrition and Characteristicsmentioning

confidence: 99%

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Prevalence and Clinical Characteristics of Nontuberculous Mycobacteria in Patients with Bronchiectasis: A Systematic Review and Meta-Analysis

Zhu

Xie

et al. 2021

Respiration

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Background: Although international bronchiectasis guidelines recommended screening of nontuberculous mycobacteria (NTM) both at initial evaluation and prior to administration of macrolide treatment, data regarding NTM in bronchiectasis remain elusive. Objective: To establish the prevalence, species, and clinical features of NTM in adults with bronchiectasis. Methods: We searched PubMed, Embase, and Web of Science for studies published before April 2020 reporting the prevalence of NTM in adults with bronchiectasis. We only included studies with bronchiectasis confirmed by computed tomography and NTM identified by mycobacteria culture or molecular methods. Random-effects meta-analysis was employed. Results: Of the 2,229 citations identified, 21 studies, including 12,454 bronchiectasis patients were included in the final meta-analysis. The overall pooled prevalence of NTM isolation and pulmonary NTM disease were 7.7% (5.0%–11.7%) (n/N = 2,677/12,454) and 4.1% (1.4%–11.4%) (n/N = 30/559), respectively, with significant heterogeneity (I2 = 97.7%, p < 0.001 and I2 = 79.9%, p = 0.007; respectively). The prevalence of NTM isolation varied significantly among different geographical regions with the highest isolation at 50.0% (47.3%–52.7%) reported in the United States. Mycobacterium avium complex and Mycobacterium abscessus complex accounted for 66 and 16.6% of all species, respectively. Some clinical and radiological differences were noted between patients with and without the presence of NTM isolation although the results are inconsistent. Conclusions: Heterogeneity in prevalence estimates of NTM isolation indicated that both local surveys to inform development of clinical services tailored to patients with bronchiectasis and population-based studies are needed. The clinical features associated with NTM in bronchiectasis and their incremental utility in studying the association is unknown and merits further investigation.

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Global prevalence of non-tuberculous mycobacteria in adults with non-cystic fibrosis bronchiectasis 2006–2021: a systematic review and meta-analysis

Zhou

Zhang

et al. 2022

BMJ Open

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ObjectiveTo accurately estimate the global prevalence of non-tuberculous mycobacteria (NTM) in adults with non-cystic fibrosis (non-CF) bronchiectasis and to determine the proportion of NTM species and subspecies in clinical patients from 2006 to 2021.DesignSystematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMedline, Embase, Cochrane Library and Web of Science were searched for articles published between 2006 and 2021.Eligibility criteria for selecting studiesWe included all the prospective or retrospective studies without language restrictions and all patients were adults (≥18 years of age) with non-CF bronchiectasis. The studies estimated the effect size of the prevalence of NTM with a sample size ≥40, and patients were registered in and after 2006.Data extraction and synthesisTwo reviewers screened the titles, abstracts and full texts independently. Relevant information was extracted and curated into tables. Risk of bias was evaluated following the Cochrane Collaboration’s tool. Meta-analysis was performed with software R Statistics V.3.6.3 using random effect model with 95% CI. I2 index and Q statistics were calculated to assess the heterogeneity, and mixed-effects meta-regression analyses were performed to identify the sources of heterogeneity. The proportions of NTM subspecies were examined using Shapiro-Wilk normality test in R.ResultsOf all the 2014 studies yielded, 24 met the inclusion criteria. Of these, 14 were identified to be randomised controlled studies and included for an accurate estimation. The global prevalence of NTM in adults with non-CF bronchiectasis from 2006 to 2021 was estimated to be approximately 10%, with great variations primarily due to geographical location. Mycobacterium avium complex was the most common subspecies, followed by Mycobacterium simiae and Mycobacterium gordonae.ConclusionsThe prevalence of NTM in adults with non-CF bronchiectasis has been on the rise and the most common subspecies changed greatly in recent years. More cohort studies should be done in many countries and regions for future estimates.PROSPERO registration numberCRD42020168473.

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Etiology, Clinical, Radiological, and Microbiological Profile of Patients with Non-cystic Fibrosis Bronchiectasis at a Tertiary Care Hospital of Pakistan

Cited by 7 publications

References 26 publications

Post Tuberculosis (TB) Bronchiectasis versus Non-TB Bronchiectasis in Northern Pakistan: A single centre retrospective cohort study on frequency, demographics, microbiology, and complications

Post Tuberculosis (TB) Bronchiectasis versus Non-TB Bronchiectasis in Northern Pakistan: A single centre retrospective cohort study on frequency, demographics, microbiology, and complications

Prevalence and Clinical Characteristics of Nontuberculous Mycobacteria in Patients with Bronchiectasis: A Systematic Review and Meta-Analysis

Global prevalence of non-tuberculous mycobacteria in adults with non-cystic fibrosis bronchiectasis 2006–2021: a systematic review and meta-analysis

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