Increasing nontuberculous mycobacteria infection in cystic fibrosis

Ophir Bar-On, Huda Mussaffi, Meir Mei-Zahav, Dario Prais, Guy Steuer, Patrick Stafler, Shai Hananya, Hannah Blau*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Nontuberculous mycobacteria (NTM) are emerging infections in the CF population. Aims: To assess NTM infection prevalence and associated features in our CF clinic population. Methods: Patient records, 2002-2011, were reviewed for NTM infection. FEV1, pancreatic function, sputum microbiology, and serum cytokines were compared in patients with and without NTM infection. Results: Incidence rate of NTM infection increased from 0 in 2002 to 8.7% in 2011 (p. <. 0.001). NTM infection prevalence increased 3-fold from 5% (4/79) in 2003 to 14.5% (16/110) in 2011 (p. = 0.05). Prevalence of chronic NTM lung disease has decreased somewhat since a peak in 2009, with institution of aggressive triple therapy. Of NTM-infected compared to uninfected patients, 88.2% vs. 60.3% had a known 'severe' CFTR genotype (p. = 0.04), 88.2% vs. 58.9% were pancreatic insufficient (p. = 0.02); 70.6% vs. 43.8% had chronic Pseudomonas aeruginosa (p. = 0.06); 75% vs. 32% had Aspergillus infection (p. = 0.007) and 23.5% vs 2.7% had allergic bronchopulmonary aspergillosis (p. = 0.01). Patients infected with Mycobacterium abscessus had increased TGF-β, TNF-α, IL-1β, IL-2, IL-4 and IL-5 levels (p. <. 0.05). There was no difference in cytokine levels for all NTM infected compared to uninfected patients. M. abscessus comprised 46% of all NTM infections. Comparing M. abscessus versus other NTM, duration was 10.5 (1-118) months versus 1 (1-70) month, median (range) (p. = 0.004); lung disease occurred in 69% versus 17% (p. = 0.0004), with sputum conversion in 4/11 versus 5/6, respectively (NS). Conclusions: NTM incidence and prevalence have increased dramatically in our CF clinic, associated with a severe CF genotype and phenotype. M. abscessus, the most prevalent NTM, caused prolonged infection despite therapy. There has been some decrease in the prevalence of NTM lung disease since 2009.

Original languageEnglish
Pages (from-to)53-62
Number of pages10
JournalJournal of Cystic Fibrosis
Volume14
Issue number1
DOIs
StatePublished - 1 Jan 2015

Keywords

  • Allergic bronchopulmonary aspergillosis
  • Cystic fibrosis
  • Mycobacterium abscessus
  • Nontuberculous mycobacteria

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