Mycobacterial infections in adult patients with hematological malignancy

Abstract

We retrospectively analyzed the clinical and microbiological characteristics of adult patients with hematological malignancy and nontuberculous mycobacteria (NTM) infections from 2001 to 2010. During the study period, 50 patients with hematological malignancy and tuberculosis (TB) were also evaluated. Among 2,846 patients with hematological malignancy, 34 (1.2%) patients had NTM infections. Mycobacterium avium-intracellulare complex (13 patients, 38%) was the most commonly isolated species, followed by M. abscessus (21%), M. fortuitum (18%), and M. kansasii (18%). Twenty-six patients had pulmonary NTM infection and eight patients had disseminated disease. Neutropenia was more frequently encountered among patients with disseminated NTM disease (p = 0.007) at diagnosis than among patients with pulmonary disease only. Twenty-five (74%) patients received adequate initial antibiotic treatment. Five of the 34 patients died within 30 days after diagnosis. Cox regression multivariate analysis showed that chronic kidney disease (p = 0.017) and neutropenia at diagnosis (p = 0.032) were independent prognostic factors of NTM infection in patients with hematological malignancy. Patients with NTM infection had higher absolute neutrophil counts at diagnosis (p = 0.003) and a higher 30-day mortality rate (15% vs. 2%, p = 0.025) than TB patients. Hematological patients with chronic kidney disease and febrile neutropenia who developed NTM infection had significant worse prognosis than patients with TB infection.

Health‐related quality of life, comorbidities and mortality in pulmonary nontuberculous mycobacterial infections: A systematic review

“…20 Table 1 (Table S1 for full table) shows the study and patient characteristics of studies on pulmonary NTM disease (n = 13) and studies on both pulmonary and extra-pulmonary NTM diseases combined (n = 4). Studies examined the following outcomes: HRQOL alone (n = 2), 21,22 comorbidities alone (n = 1), 23 mortality alone (n = 11), 20,[24][25][26][27][28][29][30][31][32][33] and both comorbidities and mortality (n = 3). 9,34,35 The earliest study date was 1990 while the remaining spanned from 2003 to 2014.…”

“…Five studies examined populations with other underlying conditions. In haematological malignancy (n = 84), 26 30-day survival was worse in those with pulmonary and extra-pulmonary NTM than TB (log-rank test: P = 0.03). In rheumatoid arthritis (n = 124 019), 25 the odds of dying by the end of followup were 81% greater (HR (95% CI): 1.81 (1.5-2.1)) in pulmonary and extra-pulmonary NTM disease.…”

“…Most studies examined all-cause mortality (n = 11) 20,[24][25][26][27][28][29][31][32][33][34] while the remaining were infection specific. 9,30,35 Follow-up time ranged from 30 days 26 to over 10 years.…”

“…9,30,35 Follow-up time ranged from 30 days 26 to over 10 years. 30 Four studies were drawn from the same hospital settings, 26,27,31,32 producing an over-representation of a small group of individuals.…”

Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Can Accurately Differentiate between Mycobacterium masilliense (M. abscessus subspecies bolletti) and M. abscessus ( Sensu Stricto )

“…In contrast, the clarithromycin MIC values of 33 of 36 M. massiliense isolates were Յ2 g/ml when the broth susceptibility test results were read on day 5; however, 11 (33.3%) of the 33 isolates exhibited clarithromycin MICs of Ͼ16 (Ն32) g/ml during the 14-day observation. Previous studies have shown that rapidly growing mycobacteria, especially those of the M. abscessus complex, are the most common clinical isolates of mycobacteria and are a major cause of pulmonary disease due to nontuberculous mycobacteria (NTM) in Asia (2,3,(18)(19)(20). Saleeb et al reported that MALDI-TOF MS can be incorporated into the work flow of the microbiology laboratory for rapid and accurate identification of most species of mycobacteria (16).…”