title: Increasing nontuberculous mycobacteria infection in cystic fibrosis.
abstract: BACKGROUND
  Nontuberculous mycobacteria (NTM) are emerging infections in the CF population.
  
  
  OBJECTIVE
  To assess NTM infection prevalence and associated features in our CF clinic population.
  
  
  METHODS
  Patient records, 2002-2011, were reviewed for NTM infection. FEV1, pancreatic function, sputum microbiology, and serum cytokines were compared in patients with and without NTM infection.
  
  
  RESULTS
  Incidence rate of NTM infection increased from 0 in 2002 to 8.7% in 2011 (p<0.001). NTM infection prevalence increased 3-fold from 5% (4/79) in 2003 to 14.5% (16/110) in 2011 (p=0.05). Prevalence of chronic NTM lung disease has decreased somewhat since a peak in 2009, with institution of aggressive triple therapy. Of NTM-infected compared to uninfected patients, 88.2% vs. 60.3% had a known 'severe' CFTR genotype (p=0.04), 88.2% vs. 58.9% were pancreatic insufficient (p=0.02); 70.6% vs. 43.8% had chronic Pseudomonas aeruginosa (p=0.06); 75% vs. 32% had Aspergillus infection (p=0.007) and 23.5% vs 2.7% had allergic bronchopulmonary aspergillosis (p=0.01). Patients infected with Mycobacterium abscessus had increased TGF-β, TNF-α, IL-1β, IL-2, IL-4 and IL-5 levels (p<0.05). There was no difference in cytokine levels for all NTM infected compared to uninfected patients. M. abscessus comprised 46% of all NTM infections. Comparing M. abscessus versus other NTM, duration was 10.5 (1-118) months versus 1 (1-70) month, median (range) (p=0.004); lung disease occurred in 69% versus 17% (p=0.0004), with sputum conversion in 4/11 versus 5/6, respectively (NS).
  
  
  CONCLUSIONS
  NTM incidence and prevalence have increased dramatically in our CF clinic, associated with a severe CF genotype and phenotype. M. abscessus, the most prevalent NTM, caused prolonged infection despite therapy. There has been some decrease in the prevalence of NTM lung disease since 2009.
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel.
authors.forename: Ophir
authors.initials: O
authors.lastname: Bar-On
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Huda
authors.initials: H
authors.lastname: Mussaffi
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Mei-Zahav
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Dario
authors.initials: D
authors.lastname: Prais
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Steuer
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stafler
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Hananya
authors.affiliation: Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel. Electronic address: hblau@post.tau.ac.il.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blau
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Allergic bronchopulmonary aspergillosis; Cystic fibrosis; Mycobacterium abscessus; Nontuberculous mycobacteria