Outcome of patients with and poor prognostic factors for Mycobacterium kansasii-pulmonary disease

Chia-Jung Liu; Hung-Ling Huang; Meng-Hsuan Cheng; Po-Liang Lu; Chin-Chung Shu; Jann-Yuan Wang; Inn-Wen Chong

doi:10.1016/j.rmed.2019.03.015

Outcome of patients with and poor prognostic factors for Mycobacterium kansasii-pulmonary disease

Respir Med. 2019 May:151:19-26. doi: 10.1016/j.rmed.2019.03.015. Epub 2019 Mar 28.

Authors

Chia-Jung Liu¹, Hung-Ling Huang², Meng-Hsuan Cheng³, Po-Liang Lu⁴, Chin-Chung Shu¹, Jann-Yuan Wang¹, Inn-Wen Chong⁵

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Departments of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: chong@kmu.edu.tw.

PMID: 31047113
DOI: 10.1016/j.rmed.2019.03.015

Abstract

Background: Aggressive therapy for Mycobacterium kansasii-pulmonary disease (MK-PD) is recommended because of the virulence of MK. However, some clinicians may be concerned regarding the lengthy course and numerous adverse effects. This study evaluated the natural course of MK-PD and investigated its prognostic factors.

Methods: Radiographic outcome, prognostic factors, and mortality within 1 year for MK-PD were obtained from patients in 6 hospitals in Taiwan from 2010 to 2014 (derivation cohort) and validated using patients in 2015 and 2016 (validation cohort).

Results: Of the 109 patients with MK-PD in the derivation cohort, radiographic progression occurred in 70 (64%), with a 1-year mortality rate of 43% and median survival of 71 days, whereas none of the 39 cases without radiographic progression died. All patients with acid-fast smear (AFS) grade ≥ 3 experienced radiographic progression. For the others, the independent risk factors of radiographic progression were fibroCavitary pattern, Leucocyte count >9000/μL, Old age (age >65 years), pUre MK in sputum (no other mycobacteria), and no Diabetes mellitus (the CLOUD factors). By applying these criteria to the validation cohort (n = 112), 3 (9%) of the 33 patients with MK-PD who initially had AFS grade < 3 and < 3 CLOUD risk factors experienced radiographic progression, and none of the 3 died of MK-PD.

Conclusions: Because of the high risk of radiographic progression and subsequent fatal outcome, immediate anti-MK treatment is recommended. For patients with MK-PD who have sputum AFS grade <3 and < 3 CLOUD risk factors, regular follow-up may be an alternative.

Keywords: Acid-fast smear; Mycobacterium kansasii; Prognosis; Pulmonary disease; Radiographic progression.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Body Mass Index
Cohort Studies
Disease Progression
Female
Humans
Leukocytosis
Lung Diseases / diagnostic imaging
Lung Diseases / microbiology*
Lung Diseases / mortality
Male
Mycobacterium Infections, Nontuberculous / diagnostic imaging
Mycobacterium Infections, Nontuberculous / mortality*
Mycobacterium kansasii*
Prognosis
Radiography
Retrospective Studies
Risk Factors
Sputum / microbiology
Taiwan / epidemiology