Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease.
BACKGROUND
Respiratory specimens with nontuberculous mycobacteria (NTM) are increasingly common; however, pulmonary disease prevalence is unknown.


OBJECTIVE
To determine the disease prevalence, clinical features, and risk factors for NTM disease, and to examine the predictive value of the microbiologic criteria of the American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) pulmonary NTM case definition for true NTM disease.


METHODS
We identified all Oregon residents during 2005-2006 with at least one respiratory mycobacterial isolate. From a population-based subset of these patients, we collected clinical and radiologic information and used the ATS/IDSA pulmonary NTM disease criteria to define disease.


RESULTS
In the 2-year time period, 807 Oregonians had one or more respiratory NTM isolates. Four hundred and seven (50%) resided within the Portland metropolitan region, among which 283 (70%) had evaluable clinical records. For those with records, 134 (47%) met ATS/IDSA pulmonary NTM disease criteria for a minimum overall 2-year period prevalence of 8.6/100,000 persons, and 20.4/100,000 in those at least 50 years of age within the Portland region. Case subjects were 66 years of age (median; range, 12-92 yr), frequently female (59%), and most with disease caused by Mycobacterium avium complex (88%). Cavitation (24.5%), bronchiectasis (16%), chronic obstructive pulmonary disease (28%), and immunosuppressive therapy (25.5%) were common. Eighty-six percent of patients meeting the ATS/IDSA microbiologic criteria for disease also met the full ATS/IDSA disease criteria.


CONCLUSIONS
Respiratory NTM isolates frequently represent disease. Pulmonary NTM disease is not uncommon, particularly among elderly females. The ATS/IDSA microbiologic criteria are highly predictive of disease and could be useful for laboratory-based NTM disease surveillance.
Oregon Health & Science University, Portland, OR 97239, USA. Winthrop@ohsu.edu
Kevin L
KL
Winthrop
Erin
E
McNelley
Brian
B
Kendall
Allison
A
Marshall-Olson
Christy
C
Morris
Maureen
M
Cassidy
Ashlen
A
Saulson
Katrina
K
Hedberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000382:microbiology; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000453:epidemiology* / Q000517:prevention & control; D009922:Oregon / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors