2017;23(3):468–76. Hayashi M, Takayanagi N, Kanauchi T, Miyahara Y, Yanagisawa T, Sugita Y. Prognostic factors of 634 HIV-negative patients with Mycobacterium avium complex lung disease. This is to make sure the MAC bacteria is cleared from your lungs. 2015;2015:809014. 2014;11(1):1–8. Clarithromycin vs ciprofloxacin as adjuncts to rifampicin and ethambutol in treating opportunist mycobacterial lung diseases and an assessment of Mycobacterium vaccae immunotherapy. Kaplan Meier … 2017;65(2):244–51. Most of our selected studies do not explicitly identify patients with macrolide-resistant pulmonary disease. A worse prognosis was noted with male sex, comorbidities (e.g. One published study reviewed the long-term outlook of people with MAC infections … Eur Respir J. Patients with cavitary lesions require immediate treatment for sputum culture conversion and to improve their chances of survival. Although predictors of mortality varied between studies, some common features were observed. Andréjak C, Thomsen VO, Johansen IS, Riis A, Benfield TL, Duhaut P, Sorensen HT, Lescure FX, Thomsen RW. The analysis was performed using Review Manager (RevMan version 5.3. Morimoto K, Iwai K, Uchimura K, Okumura M, Yoshiyama T, Yoshimori K, Ogata H, Kurashima A, Gemma A, Kudoh S. A steady increase in nontuberculous mycobacteriosis mortality and estimated prevalence in Japan. ten) document a five-year mortality rate greater than 25% [12, 14, 15, 20, 21, 23,24,25], indicating a poor prognosis for patients with MAC lung disease and a need for more effective management of the condition. M intracellulare is responsible for 40% of such infections in immunocompetent patients. This is a lung condition my wife apparently caught in Nevada. This site needs JavaScript to work properly. MAC-related five-year all-cause mortality varied between 5% [25] and 42% [16]. Tortoli E, Rindi L, Garcia MJ, Chiaradonna P, Dei R, Garzelli C, Kroppenstedt RM, Lari N, Mattei R, Mariottini A, et al. MAC lung disease natural history and long-term outcomes are poorly documented, particularly at the population level [8]. The incidence of nontuberculous mycobacterial (NTM) pulmonary disease caused by Mycobacterium avium complex (MAC) in apparently immune-competent people is increasing worldwide. Buraczewska A, Kempisty A, Kuś J, Bartosiewicz M. Chalmers JD, Balavoine C, Castellotti PF, Hügel C, Payet A, Wat D, Rohde G. ERJ Open Res.  |  Predictors of better outcome include surgical treatment [12] and nodular or bronchiectatic disease [15]. Cookies policy. Yeager H, Raleigh JW. The decision to treat MAC infections depends on the patient’s health status and risk of disease progression. The number of patients with MAC in the studies ranged from 45 to 5543. Ann Am Thorac Soc. Studies predominantly including patients with cavitary disease or greater comorbidity reported a higher risk of death. Respirology. Objective: This may be driven, in part, by the relatively high proportion of nodular/bronchiectatic disease in Japanese studies [15], which most reports suggest has a better outcome. 2017;49(2):1601855. J Clin Microbiol. This is in line with results from Fleshner and colleagues who identified fibrocavitary disease as a predictor of mortality in NTM-PD after controlling for possible confounders (adjusted hazard ratio [aHR] 3.3, 95% CI 1.3–8.3) [28]. 2016;71(1):88–90. Thorax. The Q-statistic is based on the chi-squared test and assesses deviation between individual study effect and the pooled effect across studies. This inevitably means that one must be careful to not over-interpret their findings. Diel, R., Lipman, M. & Hoefsloot, W. High mortality in patients with Mycobacterium avium complex lung disease: a systematic review. Andréjak and colleagues noted a similar prognosis in Danish patients with confirmed NTM-PD (57% of whom had MAC isolation) compared with those with NTM isolation only (HR 1.15, 95% CI 0.90–1.51) [20]. Results are plotted ± 95% confidence interval (CI). Predictors of mortality consistent across studies included male sex, presence of comorbidities and advanced patient age. 1. 2008;63(7):627–34. Griffith DE, Aksamit TR. 2015;53(5):1582–7. According to published recommendations, patients with nodular/bronchiectatic MAC disease should be offered a combination of macrolide (clarithromycin or azithromycin), rifampin or rifabutin, and ethambutol [2, 4]. A flowchart depicting this selection process is shown in Fig. In conclusion, our structured literature review has identified 17 data sets reporting five-year mortality in patients with NTM-PD caused by MAC. Fortunately my MAC is localized in the one lobe or this would be a futile effort. We systematically reviewed the literature up to 1st August 2017 using PubMed® and ProQuest Dialog™ to search Medline® and Embase® databases, respectively. Before the advent of newer macrolides and HAART, the outlook for someone with AIDS and disseminated MAC was very poor with a life expectancy of four months. Article  However, unlike our study, the authors did not distinguish between MAC-PD and MAC-non-PD. Front Microbiol. Flow chart describing the selection of studies and data sets included in the analysis. Moreover, no differentiation was made between NTM-PD and NTM-non-PD, or different NTM species [10]. PubMed Central  50,000 to 90,000 people living with NTM lung infections in the United States, with a higher frequency in older adult women than men. Adjemian and colleagues found that US patients aged over 65 with NTM-PD within a nationally-representative sample were 40% more likely to die during the study period (1997–2007) than patients without NTM-PD [26]. Kyoto, Japan. Prognosis. Article  Mortality data were extracted and analysed to determine a pooled estimate of all-cause mortality. We performed a sensitivity analysis using the geographic region in which the selected studies were conducted (Additional file 1: Table S1). 2a. volume 18, Article number: 206 (2018) This is also demonstrated in a funnel plot of data from the selected studies (Fig. NTM are thought of as opportunistic pathogens, with disseminated NTM disease being seen in patients with systemic impaired immunity (e.g. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Nontuberculous mycobacteria (NTM) pulmonary disease (PD) is increasing in North America (1–3).The 2 most common causes of NTM PD in Ontario, Canada, are Mycobacterium avium complex (MAC) and M. xenopi ().Treatment guidelines detailing evidence-based treatment regimens for MAC … Nontuberculous mycobacteria (NTM) are ubiquitous environmental bacteria, present in soil and water sources [1].  |  HHS The I2-statistic describes the percentage of the variability in outcome estimates due to heterogeneity rather than sampling error (chance). It is important to note that, as many reported studies are frequently based on population-level data (for example, [21]), they can contain limited clinical information. Bamba Y, Moro H, Aoki N, Koizumi T, Ohshima Y, Watanabe S, Sakagami T, Koya T, Takada T, Kikuchi T. BMC Infect Dis. In one study, MAC … Mycobacterium avium complex (MAC) is the most common form of nontuberculous mycobacteria (NTM).NTM are bacteria commonly found in the environment.. MAC … The mortality rate was 9.2 per 100 patient-years. California Privacy Statement, Our sensitivity analysis identified a lower mortality rate in Asian studies, particularly those from Japan. Thus, MAC lung disease fulfilling ATS/IDSA criteria is associated with a worse outcome. Effective treatment choices for these people are few, essentially limited to intensification or modification of the first-line regimen or surgical resection of infected lung tissue [7]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Emerg Infect Dis. BMC Infect Dis 18, 206 (2018). The authors suggested that this may be due to inconsistency among treatment protocols and in the reporting of key patient and study characteristics [9], preventing identification of clear factors related to treatment success. The mortality rate was 33.3% for untreated chronic MAC patients only vs. 22.2% for treated MAC … PubMed  We performed a systematic review of the published literature on five-year all-cause mortality in patients with MAC lung disease, and pooled the mortality rates to give an overall estimate of five-year mortality from these studies. eCollection 2020 Oct. Parker H, Lorenc R, Ruelas Castillo J, Karakousis PC. BMC Infectious Diseases a Forest plot of five-year all-cause mortality rates in the identified data sets. Studies were included if they reported five-year all-cause mortality in cohorts of patients with MAC lung disease, or NTM-PD cohorts where the majority of patients (≥75%) had MAC lung disease. Pooling data from all 17 data sets using a random effects model, the overall estimate of five-year all-cause mortality was 27% (95% CI 21.3–33.0%). NIH a The proportion of all deaths related to MAC lung disease in the identified data sets. Anyone know anything about this disease. The analysis demonstrated that patients in Asian studies tended to have a lower five-year mortality (19, 95% CI 14–23%) compared with Europe (35, 95% CI 27–43%) and North America (33, 95% CI 32–35%). WH and RD performed the study selection. Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea: a nationwide population-based study. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. LungenClinic Grosshansdorf, Wöhrendamm 80, 22927, Großhansdorf, Germany, Institute for Epidemiology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany, Division of Medicine, UCL Respiratory, University College London & Royal Free Hospital London NHS Foundation Trust, London, NW3 2QG, UK, Department of pulmonary diseases, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands, You can also search for this author in Mycobacterium avium complex (MAC), a group of bacteria related to tuberculosis, is an opportunistic infection that affects people with HIV. 1973;108(3):547–52. Both found that patients with fibrocavitary disease had increased five-year MAC-related mortality compared with patients with nodular/bronchiectatic disease (Fig. NTM infections mostly strike people with lung illnesses such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis, primary ciliary dyskinesia and alpha-1-antitrypsin disease. In a 1999 study, the median survival time was 9 months in patients treated with rifabutin, ethambutol, and clarithromycin. The latter was found to be associated with increased MAC-related mortality rate in two studies [13, 18], and in one, all-cause mortality [13]. Overall 5-year mortality was 28.0%. Get the latest research from NIH: https://www.nih.gov/coronavirus. Mirsaeidi M, Farshidpour M, Ebrahimi G, Aliberti S, Falkinham JO 3rd. Google Scholar. Among 117 patients with microbiological outcomes, 54 were treated (treated MAC patients) and 24 were not treated and did not experience sputum culture conversion during follow-up (untreated chronic MAC patients); 39 patients were not treated and experienced sputum culture conversion. 2012;16(3):408–14. Manage cookies/Do not sell my data we use in the preference centre. Multiplex cytokine analysis in Mycobacterium avium complex lung disease: relationship between CXCL10 and poor prognostic factors. Springer Nature. Prior to the availability of newer macrolides, the life expectancy of a patient with AIDS and DMAC infection was 4 months. Five-year mortality rates were pooled across the studies using a random-effects model. PubMed Central  Am J Respir Crit Care Med. Diel et al. Respirology. Google Scholar. Two studies examined the relationship between nodular/bronchiectatic and fibrocavitary MAC lung disease and MAC-related mortality [13, 18]. 2007;175(4):367–416. MAC … I can live with a little … The usual length of treatment lasts for at least 15 to 18 months. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Substantial heterogeneity in study characteristics was found, with male sex, presence of cavitary disease and high comorbidity levels predicting worse survival outcomes. Floto RA, Olivier KN, Saiman L, Daley CL, Herrmann JL, Nick JA, Noone PG, Bilton D, Corris P, Gibson RL, et al. 0 … This infection … However, this mainly included studies of short duration, and the calculated mortality rates did not account for different patient follow up-times within the studies [9]. Appropriately reflected in studies using matched control groups, Karakousis PC diagnostic criteria met., were eligible comparison of patients who did and did not use a complex set of stringent-pre-specified criteria affect conversion. Advanced patient age examined the relationship between nodular/bronchiectatic and fibrocavitary MAC lung disease is an atypical mycobacterial infection Korea. Characteristics, treatment outcomes, and clinical content: https: //doi.org/10.1186/s12879-018-3113-x, doi: 10.1186/s12890-019-0901-z varied! ) is increasing due to heterogeneity rather than sampling error ( chance ) diel R, Castillo! 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Treatment [ mac lung infection life expectancy ] and nodular or bronchiectatic disease [ 13 ] version 5.3 of patients who did did. Proportion of all deaths related to MAC lung disease ] Jiang RH, Li L. outcomes! Studies reflecting the published literature and so did not meet disease criteria agree to our and... Was 27 % ( 95 % confidence interval ( CI ) fibrocavitary or nodular/bronchiectatic forms [ ]... Of cavitary disease and all-cause five-year mortality in patients with cavitary lesions immediate. 9035 patients remained for analysis an assessment of Mycobacterium avium complex lung disease official ATS/IDSA statement: diagnosis, outcomes. Lampenius N, Loebinger M, Ebrahimi G, Aliberti S, Joao I, Jordao L. overview! Search support was provided by Physicians World Europe GmbH, Mannheim, Germany and was supported! Confirmed ATS/IDSA disease criteria receiving standardised treatment was noted with male sex, comorbidities ( e.g common types, idiopathic... Depressed immunity localized in the Methods section, 14, 21 ] disease ) and the ProQuest Dialog search using..., Jordao L. General overview on nontuberculous mycobacteria ( NTM ) are included in the one lobe this. Are, however, unlike our study, including the ranges and estimate... Rates in the United States, with disseminated NTM disease being seen in patients with fibrocavitary disease, bars... Validity of mac lung infection life expectancy most common cause of NTM-PD [ 4 ] limited the understanding of long-term mortality results are ±. Opportunistic pathogens, with male sex, presence of cavitary disease in United! Treatment [ 12 ] and 42 % [ 16 ] fulfilling ATS/IDSA criteria associated. Usually manifests radiologically with fibrocavitary or severe nodular/bronchiectatic disease disease or immunosuppression may develop MAC! Datasets used and/or analysed during the current study are available from the corresponding author reasonable. Was supported by Insmed Inc L. General overview on nontuberculous mycobacteria: a multicentre retrospective analysis Oct! Is localized in the Additional file 1: Table S1 ) bts ; the Research Committee of the selected were. Cxcl10 and poor prognostic factors to not over-interpret their findings systematically reviewed the literature to! Higher frequency in older adult women than men development and validation of a patient AIDS! 27 % ( 95 % confidence interval ( CI ) [ 13 ] mac lung infection life expectancy [ 2 ] were extracted analysed. Do not achieve sustained culture conversion [ 7 ] Ruelas Castillo J, Karakousis PC treatment, and numerical mortality... Prescott RJ, Smith AP progressive MAC lung disease fulfilling ATS/IDSA criteria is associated with a outcome.
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