Incidence and outcomes of Mycobacterium abscesssus infections in non-Cystic Fibrosis patients

Le résumé fourni par la source

Over recent years the incidence of Mycobacterium abscessus infection has been increasing in patients with Cystic Fibrosis (CF). The reason for this increase is far from clear; in our patients with CF in Leeds ten per cent of all adult patients have cultured M. abscessus. We were keen to explore the incidence retrospectively in non-CF patients and whether any correlations could be identified. Between 2010 and 2018 we identified patients who had cultured positive for M. abscessus on respiratory samples. Seventeen patients were identified as having repeated positive cultures. There was no evidence of increasing incidence over this period. All seventeen patients presented with increased cough, five (29%) also had significant haemoptysis. On CT scan 4/15 (27%) had nodules or tree in bud changes and 6/15 (40%) cavitation. Two patients did not have a CT scan. Eight patients had a history of chronic respiratory disease (4 COPD, 2 pulmonary fibrosis, and 2 asthma). Three patients were immunocompromised (2 autoimmune disease and 1 leukaemia). Interestingly, 14/17 (82%) had a strong history of gastroesophageal reflux disease and were receiving proton pump inhibitors. Three patients (18%) had coeliac disease. Only three patients had evidence of progressive M. abscessus infection requiring treatment, one of these died. In the other 14 patients only 3 patients had long term positive samples with 11 (65%) clearing the M. abscessus without treatment. In conclusion, the incidence of M abscessus does not seem to be increasing in non-CF patients in our institution. There may be an epidemiological link with acid suppression and reflux disease, this hypothesis has been previously reported in patients with CF.

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