Lung Manifestations in an Autopsy-Based Series of Pulmonary or Disseminated Nontuberculous Mycobacterial Disease

Abstract

Background: Comparisons of lung manifestations in primary pulmonary vs disseminated nontuberculous mycobacterial disease have not been well described. The clinical, histopathologic, and radiologic disease manifestations of primary pulmonary or disseminated nontuberculous mycobacterial disease were compared in an autopsy series. Methods: Medical and microbiologic records, autopsy reports, histopathologic slides of the lungs, and chest CT scans were reviewed on patients at the National Institutes of Health with nontuberculous mycobacterial disease who died between 1996 and 2010. Results: The 11 patients with primary pulmonary nontuberculous mycobacterial disease were predominantly female (n 5 9), with symptom onset at median 50 (range 35, 71) years and time from onset until death of 12 (3, 34) years. Bronchiectasis with cavity formation and necrotizing bronchocentric granulomatous infl ammation predominated but extrapulmonary infection was absent. The fi ve patients with disseminated disease and systemic immune defects were all men with age at onset of 2 (0.33, 33) years and time from onset of disease until death of 9 (1, 31) years. Miliary nodules and/or consolidation with poorly formed granulomatous infl ammation were noted in the three disseminated patients with mycobacterial lung involvement. Signifi cant extrapulmonary infection was noted in all fi ve with a relative paucity of lung fi ndings. Conclusions: Nontuberculous mycobacteria can cause progressive, fatal disease. Primary pulmonary disease is bronchocentric and lacks extrathoracic infection consistent with impaired airway surface defenses. In contrast, fatal disseminated infections involving the lung have hematogenous spread, extensive extrathoracic disease, and a distinct pulmonary histopathology consistent with systemic immune dysfunction. CHEST 2012; 141(5):1203-1209Abbreviations: CF 5 cystic fi brosis; DNTM 5 disseminated nontuberculous mycobacteria; IFN-g 5 interferon-g ; IFN g R 5 interferon-g receptor; MAC 5 Mycobacterium avium complex; NF 5 nuclear factor; NIH 5 National Institutes of Health; NTM 5 nontuberculous mycobacteria; PNTM 5 pulmonary nontuberculous mycobacteria

Clonal Diversification and Changes in Lipid Traits and Colony Morphology in Mycobacterium abscessus Clinical Isolates

“…It should be noted that one of the patients in the study (patient 3) had a disseminated infection due to interferon gamma autoantibodies, the pathophysiology of which is quite different from that of idiopathic bronchiectasis (33). Nevertheless the observed changes in the pathogen genetics and colony morphology in the serial isolates from patient 3 were congruent with those for the other patient isolates.…”

Comparison of chest CT findings in nontuberculous mycobacterial diseases vs. Mycobacterium tuberculosis lung disease in HIV-negative patients with cavities

“…NTM disease and TB are similar in terms of bronchogenic spreading, but the former has a more chronic, indolent course than TB. Microscopically there was also sloughing of the epithelial lining and circumferential replacement of the bronchial wall architecture by granulomatous inflammation [29]. Such differences in the patterns of progression of the two types of infection might be responsible for the differences in CT findings.…”

Pulmonary Disease Due to Nontuberculous Mycobacteria

“…22 All patients had positive cultures for NTM (primarily MAC and M abscessus ) within 6 months of death. Patients with PNTM were predominantly women with histopathologic findings, including well-organized necrotizing and nonnecrotizing granulomatous infl ammation; a few had diff use granulomatous consolidation.…”