| Study for Clinical Characteristics of Nontuberculous Mycobacterial Pulmonary Diseases. |
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H H Pae, J H Lee, C G Yoo, C T Lee, H S Chung, Y W Kim, S K Han, Y Shim |
1Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea. hansk@snu.ac.kr
2Department of Internal Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea. |
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| Abstract |
BACKGROUND
As the prevalence of nontuberculous mycobacteriosis has been increasing rapidly, there has been recent advance in diagnostic methods and drug therapies for disease. Although the incidence of pulmonary disease caused by nontuberculous mycobacteria (NTM) has been increasing in Korea since 1990, detailed clinical description about the disease were very few. In this study we described the clinical manifestations, radiologic findings, and therapeutic outcomes of nontuberculous mycobacterial pulmonary disease. METHODS: Medical records and radiologic findings were retrospectively reviewed in 27 patients who were fulfilled the diagnostic criteria of ATS guideline for NTM pulmonary disease between January of 1990 and August of 1998 in Seoul National University Hospital (SNUH). RESULTS: Of the 27 patients, 15 were male. The mean age was 51.5 yr( +/- 11.9). Twenty patients(74.1%) had preexisting pulmonary diseases. Among them, 19 patients had previous pulmonary tuberculosis. Sixteen patients(59,2%) had cavitary lesions and the majority showed slow progression over 1 yr during follow up period on radiography. Susceptibility test to standard antituberculous drugs showed 100% resistance to INH, 72.2% to RMP, 81.5% to EMB, 92.6% to PZA. The average resistance rate to 2nd-line antituberculous drugs was 66.1%. Among twenty-one patients(77.8%) who received drug therapy over 6 months, 11 subjects were improved and 10 subjects were aggravated. Of six subjects(22.2%) without therapy, 5 patients were aggravated. Presence of cavity and less than 3 sensitive drugs in the regimen were indicators for adverse outcome. CONCLUSION: The nontuberculous mycobacterial pulmonary diseases in our hospital developed predominantly in older patients with preexistent pulmonary disease. The results of antituberculous drug therapy has been frustrating and disappointing. To improve treatment response, different susceptibility tests and drug regimens for different species of NTM should be performed. Also, diagnostic and therapeutic guidelines of Korea should be made in the recent future. |
| Key Words:
nontuberculous mycobacteria(NTM), nontuberculous mycobacterial pulmonary disease |
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