title: Clinical findings in relation to mortality in non-tuberculous mycobacterial infections: patients with Mycobacterium avium complex have better survival than patients with other mycobacteria.
abstract: We compared the clinical findings and survival in patients with Mycobacterium avium complex (MAC) and other non-tuberculous mycobacteria (NTM). A total of 167 adult non-human immunodeficiency virus (HIV) patients with at least one positive culture for NTM were included. Medical records were reviewed. The patients were categorised according to the 2007 American Thoracic Society (ATS) criteria. MAC comprised 59 % of all NTM findings. MAC patients were more often female (70 % vs. 34 %, p < 0.001) and had less fatal underlying diseases (23 % vs. 47 %, p = 0.001) as compared to other NTM patients. Symptoms compatible with NTM infection had lasted for less than a year in 34 % of MAC patients but in 54 % of other NTM patients (p = 0.037). Pulmonary MAC patients had a significantly lower risk of death compared to pulmonary other NTM (hazard ratio [HR] 0.50, 95 % confidence interval [CI] 0.33-0.77, p = 0.002) or subgroup of other slowly growing NTM (HR 0.55, 95 % CI 0.31-0.99, p = 0.048) or as rapidly growing NTM (HR 0.47, 95 % CI 0.25-0.87, p = 0.02). The median survival time was 13.0 years (95 % CI 5.9-20.1) for pulmonary MAC but 4.6 years (95 % CI 3.4-5.9) for pulmonary other NTM. Serious underlying diseases (HR 3.21, 95 % CI 2.05-5.01, p < 0.001) and age (HR 1.07, 95 % CI 1.04-1.09, p < 0.001) were the significant predictors of mortality and female sex was a predictor of survival (HR 0.38, 95 % CI 0.24-0.59, p < 0.001) in the multivariate analysis. Pulmonary MAC patients had better prognosis than pulmonary other NTM patients. The symptom onset suggests a fairly rapid disease course.
authors.affiliation: University of Helsinki and Division of Infectious Diseases, Inflammation Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland, hannele.kotilainen@welho.com.
authors.forename: H
authors.initials: H
authors.lastname: Kotilainen
authors.forename: V
authors.initials: V
authors.lastname: Valtonen
authors.forename: P
authors.initials: P
authors.lastname: Tukiainen
authors.forename: T
authors.initials: T
authors.lastname: Poussa
authors.forename: J
authors.initials: J
authors.lastname: Eskola
authors.forename: A
authors.initials: A
authors.lastname: Järvinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008171:Lung Diseases / Q000382:microbiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000472:pathogenicity*; D015270:Mycobacterium avium-intracellulare Infection / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult