Original articleIncreasing patients with pulmonary Mycobacterium avium complex disease and associated underlying diseases in Japan
Introduction
The prevalence of nontuberculous mycobacteria (NTM) disease has increased in several countries. Previous population-based studies have demonstrated a 1.5- to 3-fold increase in the isolation of NTM and the prevalence of pulmonary NTM disease in Canada, the USA, England and Australia [1], [2], [3], [4], [5]. The annual incidence of pulmonary NTM disease increased 4-fold from 2000 to 2008 at a tertiary care center in Taiwan [6]. The rate of NTM recovery from respiratory specimens increased approximately 6-fold from 2000 to 2011 at a tertiary referral hospital in South Korea [7].
Mycobacterium avium complex (MAC) disease is the most frequently observed NTM disease [8], [9], [10]. Although pulmonary MAC disease had predominantly presented in a fibrocavitary form in elderly males with chronic lung disease and cavitary disease, the prevalence of a nodular bronchiectatic form that occurs mostly in elderly female patients with no apparent preexisting lung disease has increased [10]. Among the various underlying diseases in patients with pulmonary MAC disease, chronic obstructive pulmonary disease (COPD) was more common in the USA, Denmark and Germany [8], [11], [12], whereas previous tuberculosis (TB) is more common in Japan and Korea [13], [14]. COPD and asthma patients treated with inhaled corticosteroid (ICS) therapy and patients using immunosuppressive agents and tumor necrosis factor (TNF)-α antagonists have an increased risk of pulmonary NTM disease [15], [16], [17]. However, Al-Houqani et al. reported that COPD and use of a TNF-α antagonist resulted in a smaller increase in pulmonary MAC disease [18].
In Japan, the prevalence of NTM disease was estimated to be 33–65/100,000 [19]. Although more than half of patients with pulmonary MAC disease were male in the 1980s, the number of female patients increased after 1996 and accounted for 70% of patients [20]. Although the annual incidence of pulmonary MAC disease was nearly stable in one hospital in Japan between 1996 and 2002 [20], the trend after 2003 has not been previously reported.
The aim of this study was to evaluate trends in the isolation of NTM strains, trends in the number of patients with pulmonary MAC disease and trends in their underlying diseases over a 14-year period in a university hospital in Japan.
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Materials and methods
We retrospectively reviewed microbiological results from the electronic laboratory record system at Kyoto University Hospital (1121 beds) between January 2000 and December 2013 and identified patients who met the 2007 American Thoracic Society microbiological criteria for pulmonary NTM disease [10]. Culture was performed using the BACTEC Mycobacteria Growth Indicator Tube 960 system (BD, Franklin Lakes, NJ, USA). Identification of Mycobacterium tuberculosis, M. avium and Mycobacterium
Annual incidence of mycobacterial isolates
From 2000 to 2013, the laboratory at Kyoto University Hospital received 80,285 clinical samples for mycobacterial culture. M. tuberculosis and NTM were isolated from 3777 samples (4.7%) and 6327 samples (7.9%), respectively. M. tuberculosis and NTM, respectively, were isolated from 2143 samples (5.3%) and 2473 samples (6.2%) of 40,205 samples in the early cohort and 1634 samples (4.1%) and 3854 samples (9.6%) of 40,080 samples in the late cohort. The proportion of NTM isolates among all
Discussion
In our hospital, MAC accounted for 85% of NTM species, which is consistent with a previous report in Japan [19]. The annual recovery of NTM isolates, the proportion of NTM compared with TB and the number of patients with pulmonary MAC disease increased 2-fold from 2000 to 2013. Although a trend in the incidence of NTM disease has not been reported in Japan, Morimoto et al. reported that the annual mortality rate due to NTM disease in Japan nearly doubled from 2000 to 2010, from approximately
Conflict of interest
The authors declare no conflicts of interest.
Acknowledgments
This study was supported by a Grant-in-Aid for Scientific Research by the Japanese Society for the Promotion of Science (24591479).
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