Nontuberculous mycobacterial pulmonary disease diagnosed by two methods: A prospective cohort study

Hyung Jun Kim, Jong Hyuk Lee, Soon Ho Yoon, Sung A. Kim, Myoung Sil Kim, Sun Mi Choi, Jinwoo Lee, Chang Hoon Lee, Sung Koo Han, Jae Joon Yim

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Abstract

Background: Microbiological criteria for diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD) include positive culture results from at least two separately expectorated sputum specimens or one bronchial washing or lavage. However, the clinical similarities and differences between patients diagnosed by these two methods remain unclear. We compared clinical features and prognoses of patients with NTM-PD diagnosed from both specimen types. Methods: We analysed data from patients who participated in the Seoul National University Hospital NTM-PD cohort (ClinicalTrials.gov identifier: NCT01616745). Baseline demographics, symptoms, radiographic findings, disease progression, and treatment responses were summarized and compared between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimens. Results: Three hundred forty-seven patients were included in the analyses. Of these, 279 (80.4%) were diagnosed from two separately expectorated sputum specimens, and 68 (19.6%) were diagnosed from bronchoscopic specimens. Patients diagnosed from sputum specimens had more frequent and severe cough, sputum, postnasal drip, and high St. George's Respiratory Questionnaire scores. However, the extent and severity of the radiographic lesions, disease progression, and treatment responses were similar for both groups. Further analysis based on the following three groups (sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy groups) suggested that the scanty sputum/bronchoscopy group appeared to have the worst prognosis in terms of both time to progression and time to culture conversion. Conclusions: Although some symptoms and quality of life were worse in patients with NTM-PD diagnosed from sputum specimens, their prognoses were similar to those of patients diagnosed by bronchoscopic specimen. We recommend bronchoscopic sampling for patients in whom NTM-PD is suspected clinically or radiographically, especially those who have no or scanty sputum.

Original languageEnglish
Article number468
JournalBMC Infectious Diseases
Volume19
Issue number1
DOIs
StatePublished - 24 May 2019

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Sputum
Lung Diseases
Cohort Studies
Prospective Studies
Bronchoscopy
Disease Progression
Therapeutic Irrigation
Cough
Quality of Life
Demography

Keywords

  • Clinical medicine
  • Cohort studies
  • Diagnosis
  • Nontuberculous mycobacteria
  • Progression

Cite this

@article{20a4709bb17b46f29bd6c5a3705f7597,
title = "Nontuberculous mycobacterial pulmonary disease diagnosed by two methods: A prospective cohort study",
abstract = "Background: Microbiological criteria for diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD) include positive culture results from at least two separately expectorated sputum specimens or one bronchial washing or lavage. However, the clinical similarities and differences between patients diagnosed by these two methods remain unclear. We compared clinical features and prognoses of patients with NTM-PD diagnosed from both specimen types. Methods: We analysed data from patients who participated in the Seoul National University Hospital NTM-PD cohort (ClinicalTrials.gov identifier: NCT01616745). Baseline demographics, symptoms, radiographic findings, disease progression, and treatment responses were summarized and compared between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimens. Results: Three hundred forty-seven patients were included in the analyses. Of these, 279 (80.4{\%}) were diagnosed from two separately expectorated sputum specimens, and 68 (19.6{\%}) were diagnosed from bronchoscopic specimens. Patients diagnosed from sputum specimens had more frequent and severe cough, sputum, postnasal drip, and high St. George's Respiratory Questionnaire scores. However, the extent and severity of the radiographic lesions, disease progression, and treatment responses were similar for both groups. Further analysis based on the following three groups (sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy groups) suggested that the scanty sputum/bronchoscopy group appeared to have the worst prognosis in terms of both time to progression and time to culture conversion. Conclusions: Although some symptoms and quality of life were worse in patients with NTM-PD diagnosed from sputum specimens, their prognoses were similar to those of patients diagnosed by bronchoscopic specimen. We recommend bronchoscopic sampling for patients in whom NTM-PD is suspected clinically or radiographically, especially those who have no or scanty sputum.",
keywords = "Clinical medicine, Cohort studies, Diagnosis, Nontuberculous mycobacteria, Progression",
author = "Kim, {Hyung Jun} and Lee, {Jong Hyuk} and Yoon, {Soon Ho} and Kim, {Sung A.} and Kim, {Myoung Sil} and Choi, {Sun Mi} and Jinwoo Lee and Lee, {Chang Hoon} and Han, {Sung Koo} and Yim, {Jae Joon}",
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language = "English",
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Nontuberculous mycobacterial pulmonary disease diagnosed by two methods : A prospective cohort study. / Kim, Hyung Jun; Lee, Jong Hyuk; Yoon, Soon Ho; Kim, Sung A.; Kim, Myoung Sil; Choi, Sun Mi; Lee, Jinwoo; Lee, Chang Hoon; Han, Sung Koo; Yim, Jae Joon.

In: BMC Infectious Diseases, Vol. 19, No. 1, 468, 24.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Nontuberculous mycobacterial pulmonary disease diagnosed by two methods

T2 - A prospective cohort study

AU - Kim, Hyung Jun

AU - Lee, Jong Hyuk

AU - Yoon, Soon Ho

AU - Kim, Sung A.

AU - Kim, Myoung Sil

AU - Choi, Sun Mi

AU - Lee, Jinwoo

AU - Lee, Chang Hoon

AU - Han, Sung Koo

AU - Yim, Jae Joon

PY - 2019/5/24

Y1 - 2019/5/24

N2 - Background: Microbiological criteria for diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD) include positive culture results from at least two separately expectorated sputum specimens or one bronchial washing or lavage. However, the clinical similarities and differences between patients diagnosed by these two methods remain unclear. We compared clinical features and prognoses of patients with NTM-PD diagnosed from both specimen types. Methods: We analysed data from patients who participated in the Seoul National University Hospital NTM-PD cohort (ClinicalTrials.gov identifier: NCT01616745). Baseline demographics, symptoms, radiographic findings, disease progression, and treatment responses were summarized and compared between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimens. Results: Three hundred forty-seven patients were included in the analyses. Of these, 279 (80.4%) were diagnosed from two separately expectorated sputum specimens, and 68 (19.6%) were diagnosed from bronchoscopic specimens. Patients diagnosed from sputum specimens had more frequent and severe cough, sputum, postnasal drip, and high St. George's Respiratory Questionnaire scores. However, the extent and severity of the radiographic lesions, disease progression, and treatment responses were similar for both groups. Further analysis based on the following three groups (sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy groups) suggested that the scanty sputum/bronchoscopy group appeared to have the worst prognosis in terms of both time to progression and time to culture conversion. Conclusions: Although some symptoms and quality of life were worse in patients with NTM-PD diagnosed from sputum specimens, their prognoses were similar to those of patients diagnosed by bronchoscopic specimen. We recommend bronchoscopic sampling for patients in whom NTM-PD is suspected clinically or radiographically, especially those who have no or scanty sputum.

AB - Background: Microbiological criteria for diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD) include positive culture results from at least two separately expectorated sputum specimens or one bronchial washing or lavage. However, the clinical similarities and differences between patients diagnosed by these two methods remain unclear. We compared clinical features and prognoses of patients with NTM-PD diagnosed from both specimen types. Methods: We analysed data from patients who participated in the Seoul National University Hospital NTM-PD cohort (ClinicalTrials.gov identifier: NCT01616745). Baseline demographics, symptoms, radiographic findings, disease progression, and treatment responses were summarized and compared between patients diagnosed from sputum specimens and patients diagnosed from bronchoscopic specimens. Results: Three hundred forty-seven patients were included in the analyses. Of these, 279 (80.4%) were diagnosed from two separately expectorated sputum specimens, and 68 (19.6%) were diagnosed from bronchoscopic specimens. Patients diagnosed from sputum specimens had more frequent and severe cough, sputum, postnasal drip, and high St. George's Respiratory Questionnaire scores. However, the extent and severity of the radiographic lesions, disease progression, and treatment responses were similar for both groups. Further analysis based on the following three groups (sputum culture positive, sputum culture negative/bronchoscopy, and scanty sputum/bronchoscopy groups) suggested that the scanty sputum/bronchoscopy group appeared to have the worst prognosis in terms of both time to progression and time to culture conversion. Conclusions: Although some symptoms and quality of life were worse in patients with NTM-PD diagnosed from sputum specimens, their prognoses were similar to those of patients diagnosed by bronchoscopic specimen. We recommend bronchoscopic sampling for patients in whom NTM-PD is suspected clinically or radiographically, especially those who have no or scanty sputum.

KW - Clinical medicine

KW - Cohort studies

KW - Diagnosis

KW - Nontuberculous mycobacteria

KW - Progression

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U2 - 10.1186/s12879-019-4078-0

DO - 10.1186/s12879-019-4078-0

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