Different clinical features of patients with pulmonary disease caused by various Mycobacterium avium–intracellulare complex subspecies and antimicrobial susceptibility

https://doi.org/10.1016/j.ijid.2020.06.019Get rights and content
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Highlights

  • Among the 144 patients with Mycobacterium avium pulmonary disease, 57 (39.6%), 37 (25.7%), 37 (25.7%), and 13 (9.0%) were infected with Mycobacterium intracellulare subspecies intracellulare (MIsI), M. avium subspecies hominissuis (MAsH), M. intracellulare subspecies chimaera (MIsC), and others, respectively.

  • During the 2-year follow-up, 22 (15.3%) patients reported spontaneous culture-negative conversion but 15 (10.4%) developed radiographic progression.

  • Patients with MAsH-pulmonary disease were younger, had a higher human immunodeficiency virus infection rate and a higher radiographic progression rate.

  • Among all MAC species, the susceptibility rates to clarithromycin and inhaled amikacin were both 98.6% and MAsH demonstrated the lowest rate of resistance to moxifloxacin.

Abstract

Objectives

Characteristics of the Mycobacterium aviumintracellulare complex pulmonary disease (MAC-PD) caused by distinct subspecies remain uncertain.

Methods

This study was conducted from 2013–2015 in three hospitals in Taiwan.

Results

Among the 144 patients with MAC-PD, 57 (39.6%), 37 (25.7%), 37 (25.7%), and 13 (9.0%) were infected with Mycobacterium intracellulare subspecies intracellulare (MIsI), Mycobacterium avium subspecies hominissuis (MAsH), Mycobacterium intracellulare subspecies chimaera (MIsC), and others, respectively. Patients with MAsH-PD were younger (p = 0.010) with higher human immunodeficiency virus infection rates (27.0%, 0.0%, 0.0%, and 7.7% for MAsH-PD, MIsC-PD, MIsI-PD, and others, respectively; p < 0.001). Twenty-two (15.3%) patients reported spontaneous culture-negative conversion, but 15 (10.4%) and 33 (22.9%) patients developed radiographic progression and unfavorable outcomes, especially MAsH-PD. The susceptibility rates to clarithromycin and inhaled amikacin were both 98.6%. MAsH demonstrated the lowest rate of resistance to moxifloxacin (66.7%, 97.3%, 89.1%, and 92.3% for MAsH-PD, MIsC-PD, MIsI-PD, and others, respectively; p = 0.001) and MIsI isolates had the highest rate of resistance to intravenous amikacin (25%, 13.5%, 38.2%, and 15.4% for MAsH-PD, MIsC-PD, MIsI-PD, and others, respectively; p = 0.024).

Conclusions

Pulmonary disease caused by distinct MAC subspecies had different outcomes and drug susceptibility. The local prevalence of species needs to be monitored.

Keywords

Mycobacterium aviumintracellulare complex
Mycobacterium intracellulare subspecies intracellulare
Mycobacterium avium subspecies hominissuis
Mycobacterium intracellulare subspecies chimaera
Pulmonary disease

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