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

Authors
  • Liu, Chia-Jung1
  • Huang, Hung-Ling2
  • Cheng, Meng-Hsuan3
  • Lu, Po-Liang4
  • Shu, Chin-Chung1
  • Wang, Jann-Yuan1
  • Chong, Inn-Wen5
  • 1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. , (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. , (Taiwan)
  • 3 Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. , (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. , (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: [email protected] , (Taiwan)
Type
Published Article
Journal
Respiratory medicine
Publication Date
May 01, 2019
Volume
151
Pages
19–26
Identifiers
DOI: 10.1016/j.rmed.2019.03.015
PMID: 31047113
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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). 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. 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. Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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