Journal Information
Vol. 14. Issue 3.
Pages 323-337 (May - June 2008)
Share
Share
Download PDF
More article options
Vol. 14. Issue 3.
Pages 323-337 (May - June 2008)
Artigo Original/Original Article
Open Access
Micobactérias atípicas em doentes sem síndroma de imunodeficiência adquirida
Nontuberculous mycobacteria in non-AIDS patients
Visits
5482
A. Marinho1, G. Fernandes1, T. Carvalho2, D. Pinheiro2, I. Gomes1
1 Serviço de Pneumologia do HSJ (Director: Prof. Dr. J. Agostinho Marques), Porto, Portugal / Pulmonology Unit, Hospital São João, Oporto, Portugal
2 Serviço de Microbiologia do HSJ (Directora: Prof.ª Dr.ª MJ Vaz), Porto, Portugal / Microbiology Unit, Hospital São João, Oporto, Portugal
This item has received

Under a Creative Commons license
Article information
Resumo

As micobactérias não tuberculosas (MNT) têm um papel patogénico de importância crescente em doentes com serologia positiva para o vírus da imunodeficiência humana (VIH), em doentes com doença pulmonar cró-nica, em outras doenças crónicas, e ainda nos idosos.

Objectivo: Avaliar a importância do isolamento de MNT em amostras respiratórias em doentes adultos sem infecção VIH.

Material e métodos: Estudo retrospectivo dos doentes do Hospital de São João sem infecção VIH conhe-cida, com pelo menos uma amostra respiratória positiva para MNT, entre 1997 e 2004.

Resultados: Foram encontrados 102 doentes com idade mediana de 63 anos; 67% do sexo masculino. Sessenta e três doentes (62%) apresentavam patologia respiratória prévia, maioritariamente sequelas de tu-berculose pulmonar (n=19). O agente mais isolado (47%) foi o Mycobacterium avium complex (MAC).

Foram identificados 16 casos de doença (15,7%), 14 dos quais cumpriam os critérios definidos pela American Thoracic Society. Dez homens e 6 mulheres, idade mediana de 65 anos. Doze doentes tinham doença pulmonar prévia.

Todos tinham clínica de infecção respiratória. As altera-ções mais observadas no Rx de tórax foram o infiltrado pulmonar, a opacidade linear e a cavitação. O MAC foi o causador de doença em 75% (n=12) dos casos.

Conclusão: O isolamento de micobactérias atípicas em amostras respiratórias, nomeadamente em doentes com patologia pulmonar prévia, não significou doença na grande maioria dos casos, mesmo em doentes com doença pulmonar prévia. O agente mais frequentemente isolado foi o MAC, tendo a sua importância relativa sido ainda maior nos casos de doença pulmonar por MNT.

Rev Port Pneumol 2008; XIV (3): 323-337

Palavras-chave:
Micobactérias atípicas
isolamento
doença pulmonar
Abstract

Nontuberculous mycobacteria (NTM) play an increasingly significant pathogenic role in HIV-positive patients, in patients with chronic lung disease, in other chronic conditions and in the elderly.

Aims: Evaluate the importance of NTM isolation in respiratory samples in patients without HIV-infection.

Methods: Retrospective evaluation of our hospital patients with no known AIDS, with at least one NTM positive respiratory sample, from 1997-2004.

Results: We found 102 patients, with a median age of 63 years; 67% male. Sixty-three (62%) had underlying lung disease, mainly tuberculosis sequelae (n=19). The majority (47%) of the isolations were Mycobacterium avium complex (MAC).

A diagnosis of Mycobacterium pulmonary disease was made in 16 patients (15.7%), 14 of which met the American Thoracic Society diagnostic criteria. Ten male and 6 female; median age 65 years. Twelve had underlying lung disease. All of them had respiratory infection complaints. Chest X-rays showed mainly pulmonary infiltrates, linear opacities and cavitation. MAC was the cause of mycobacterium respiratory disease in 12 patients (75%).

Conclusion: NTM isolation did not equal pulmonary NTM disease in the majority of cases, even in patients with underlying lung disease. MAC was the most commonly isolated agent and its relative importance was higher in the presence of NTM disease.

Rev Port Pneumol 2008; XIV (3): 323-337

Key-words:
Nontuberculous mycobacteria
isolation
pulmonary disease
Full text is only aviable in PDF
Bibliografia / Bibliography
[1.]
Subcommittee of Joint Tuberculosis Committee of British Thoracic Society.
Management of opportunist mycobacterial infection.
Thorax, 55 (2000), pp. 210-218
[2.]
M.T. Henry, L. Inamdar, D. O`Riordain, M. Schweiger, J.P. Watson.
Nontuberculous mycobacteria in non-HIV patients: epidemiology, treatment and response.
Eur Respir J, 23 (2004), pp. 741-746
[3.]
R.A. Timothy.
Mycobacterium avium complex pulmonary disease in patients with pre-existing lung disease.
Clin Chest Med, 23 (2002), pp. 643-653
[4.]
E. Wolinsky.
Nontuberculous mycobacteria and associated diseases.
Am Rev Respir Dis, 119 (1979), pp. 107-159
[5.]
D.S. Prince, D.D. Peterson, R.M. Steiner, et al.
Infection with Mycobacterium avium complex in patients without predisposing conditions.
N Eng J Med, 321 (1989), pp. 863-868
[6.]
M.J. Newport, C.M. Huxley, S. Huston, et al.
A mutation in the interferon-γ-receptor gene and susceptibility to mycobacterial infection.
N Engl J Med, 335 (1996), pp. 1941-1949
[7.]
S.E. Dorman, S.M. Holland.
Interferon-γ and interleukin-12 pathway defects and human disease.
Cytokine Growth Factor Rev, 11 (2000), pp. 321-333
[8.]
Diagnosis and treatment of disease caused by nontu-berculous mycobacteria.
American Thoracic Society.
Am J Respir Crit Care Med, 156 (1997), pp. S1-S25
[9.]
L. Daley Charles, Griffith E. David.
Pulmonary disease caused by rapid growing mycobacteria.
Clin Chest Med, 23 (2002), pp. 623-632
[10.]
Kenneth N. Olivier, David J. Weber, Richard J. Wallace, et al.
Nontuberculous Mycobacteria-Multicenter Prevalence Study in Cystic Fibrosis.
Am J Respir Crit Care, 167 (2003), pp. 828-834
[11.]
C.R. Esther Jr., M.M. Henry, P.L. Molina, et al.
Nontu-berculous mycobacterial infection in young children with cystic fibrosis.
Pediatr Pulmonol, 40 (2005), pp. 39-44
[12.]
C. Pierre-Audigier, A. Ferroni, I. Sermet-Gaudelas, et al.
Age-related prevalence and distribution on nontuberculous mycobacterial species among patients with cystic fibrosis.
J Clin Microbiol, 43 (2005), pp. 3467-3470
[13.]
A.F. Barker.
Bronchiectasis.
N Engl J Med, 346 (2002), pp. 1383-1393
[14.]
M. Wickremasinghe, L.J. Ozerovitch, G. Davies, et al.
Nontuberculous mycobacteria in patients with bronchiectasis.
Thorax, 60 (2005), pp. 1048-1051
[15.]
M.D. Iseman, D.L. Buschman, L.M. Ackerson.
Pectus excavatum and scoliosis: thoracic abnormalities associated with pulmonary disease caused by Mycobacterium avium complex.
Am Rev Respir Dis, 144 (1991), pp. 914-916
[16.]
S.V. Guide, S.M. Holland.
Host susceptibility factors in mycobacterial infection: genetics and body morpho-type.
Infect Dis Clin North Am, 16 (2002), pp. 163-186
[17.]
An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Disease.
Am J Respir Crit Care Med, 175 (2007), pp. 367-416
[18.]
V.O. Thomsen, A.B. Andersen, H. Miorner.
Incidence and clinical significance of non-tuberculous mycobacte-ria isolated from clinical specimens during a 2-y nation-wide survey.
Scand J Infect Dis, 34 (2002), pp. 648-653
[19.]
F. Haverkort.
National atypical mycobacteria survey, 2000.
Commun Dis Intel, 27 (2003), pp. 180-189
[20.]
W.R. Butler, J.T. Crawford.
NTM reported to the public health laboratory information system by state public health laboratories United States 1993–1996.
[21.]
N. Martin-Casabona, A.R. Bahrmand, J. Bennedsen, et al.
Non-tuberculous mycobacteria: patterns of isolation: a multi-country retrospective survey.
Int J Tuberc Lung Dis, 8 (2004), pp. 1186-1193
[22.]
L.B. Edwards, C.E. Palmer.
Isolation of «atypical» mycobacteria from health persons.
Am Rev Respir Dis, 80 (1959), pp. 747-749
[23.]
American Thoracic Society.
Diagnosis and treatment of disease caused by nontuberculous mycobacteria.
Am Rev Respir Dis, 142 (1990), pp. 940-953
[24.]
K.F. Stephen, Dina Fisher, Robert L. Cowie.
Mycobacterium avium complex pulmonary disease in patients without HIV infection.
Chest, 126 (2004), pp. 566-581
[25.]
Thomas P. Kennedy, David J. Weber.
Nontuberculous mycobacteria, an underappreciated cause of geriatric lung disease.
Am J Respir Crit Care Med, 149 (1994), pp. 1654-1658
[26.]
Judy H. Huang, Peter N. Kao, Virginia Adi, Stephen J. Ruoss.
Mycobacteruim avium-intracellulare Pulmonary Infection in HIV-negative Patients Without Pre-existing Lung Disease.
Chest, 115 (1999), pp. 1033-1040
[27.]
C. Wittram, G. Weisbrod.
Mycobacterium avium complex lung disease in immunocompetent patients: radiography-CT correlation.
The British Journal of Radiology, 75 (2002), pp. 340-344
[28.]
Y. Okada, Y. Ichinose, K. Yamaguchi, et al.
Mycobacterium avium-intracellulare pleuritis with massive pleural effusion.
Eur Respr J, 8 (1995), pp. 1428-1429
[29.]
K. Yanagihara, K. Tomono, T. Sawai, et al.
Mycobacterium avium Complex Pleuritis.
Rspiration, 69 (2002), pp. 547-549
[30.]
D.L. Levin.
Radiology of pulmonary Mycobacterium avium-intracellulare complex.
Clin Chest Med, 23 (2002), pp. 603-612
[31.]
W. Chalermskulrat, Jack Gilbey, James Donohue.
Nontuberculous mycobacterea in women, young and old.
Clin Chest Med, 23 (2002), pp. 675-686
[32.]
Kubo Keishi, Yamazaki Yoshitaka, et al.
Pulmonary infection with MAC leads to air trapping distal to the small airways.
Am J Respir Crit Care Med, 158 (1998), pp. 979-984
Copyright © 2008. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?