title: Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis.
abstract: OBJECTIVE
  Reliable markers of disease progression or stability to assist in management decisions are lacking in patients with non-cystic fibrosis bronchiectasis and Mycobacterium avium complex (MAC) infection.
  
  
  METHODS
  Data from 52 adults with non-cystic fibrosis bronchiectasis and coexisting MAC infection managed at our institution over a 5-year period were retrospectively analysed. High-resolution computed tomography (HRCT) scans were scored using a scoring system that focused on findings associated with MAC infection.
  
  
  RESULTS
  Chronic pulmonary aspergillosis was independently associated with mortality (hazard ratio (HR) = 8.916, 95% confidence interval (CI) = 1.324-60.027), as were nodules with cavitation (HR = 5.911, 95% CI = 1.095-25.911) and emphysema (HR = 1.027, 95% CI = 1.002-1.053) on HRCT. Anti-MAC chemotherapy was more likely to lead to MAC culture conversion (67% vs. 27%, P = 0.005) but did not improve survival as compared with patients managed with observation. Longitudinally, patients who had improvements in HRCT scores were younger (60.2 ± 9.19 years vs. 69.83 ± 12.43 years, P = 0.043), while the presence of cavitation within nodules predicted a deterioration in HRCT scores (0.5 (0-3) vs. 0 (0-1), P = 0.033). No significant longitudinal differences were found in lung function in the cohort as a whole or within different groups.
  
  
  CONCLUSIONS
  Chronic pulmonary aspergillosis in patients with bronchiectasis and coexisting MAC infection is a strong predictor of mortality. Cavitation within nodules and emphysema on HRCT at presentation were independently associated with mortality.
authors.affiliation: National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield Hospital Foundation Trust and Imperial College; Host Defence Unit.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Zoumot
authors.forename: Afroditi K
authors.initials: AK
authors.lastname: Boutou
authors.forename: Simon S
authors.initials: SS
authors.lastname: Gill
authors.forename: Mafalda
authors.initials: M
authors.lastname: van Zeller
authors.forename: David M
authors.initials: DM
authors.lastname: Hansell
authors.forename: Athol U
authors.initials: AU
authors.lastname: Wells
authors.forename: Robert
authors.initials: R
authors.lastname: Wilson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Loebinger
mesh_terms: D000368:Aged; D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality*; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality*; D011237:Predictive Value of Tests; D055732:Pulmonary Aspergillosis / Q000150:complications* / Q000000981:diagnostic imaging; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D003074:Solitary Pulmonary Nodule / Q000150:complications / Q000000981:diagnostic imaging; D015996:Survival Rate; D015898:Tomography Scanners, X-Ray Computed
keywords: aspergillus lung disease; atypical mycobacterial disease; bronchiectasis; respiratory infection (non-tuberculous)