Clinical Predictors of Nontuberculous Mycobacteria Lung Disease and Coisolates of Potential Pathogenic Microorganisms in Noncystic Fibrosis Bronchiectasis
Ping-Huai WangChin‐Chung ShuChau‐Chyun SheuChia‐Ling ChangMeng‐Heng HsiehWu-Huei HsuMing‐Tsung ChenWei-Fan OuYu‐Feng WeiTsung-Ming YangChou-Chin LanCheng‐Yi WangChih‐Bin LinMing‐Shian LinYao‐Tung WangChing‐Hsiung LinShih-Feng LiuMeng‐Hsuan ChengYen‐Fu ChenWen-Chien ChengChung‐Kan PengMing-Cheng ChanChing-Yi ChenLun-Yu JaoYa‐Hui WangChi-Jui ChenShih‐Pin ChenYi‐Hsuan TsaiShih-Lung ChengHorng‐Chyuan LinJung‐Yien ChienHao‐Chien Wang
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Abstract:
In bronchiectasis, nontuberculous mycobacteria (NTM) lung disease (NTM-LD) is a well-known coexisting infection. However, microorganism coisolates and clinical NTM-LD predictors are poorly studied.Keywords:
Nontuberculous Mycobacteria
Common Variable Immunodeficiency
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To assess bronchiectasis depicted with computed tomography (CT) in patients with alpha 1-antitrypsin deficiency and to examine associated clinical correlates.CT scans in 14 patients with alpha 1-antitrypsin deficiency were evaluated by two thoracic radiologists for the presence and extent of bronchiectasis and emphysema. The findings were correlated with numeric infection scores on the basis of symptoms of sputum production and respiratory infection and with a history of conditions that may predispose to development of bronchiectasis.Six (43%) of 14 patients had CT evidence of bronchiectasis. Patients with bronchiectasis had significantly higher infection scores than did patients without bronchiectasis (P < .005). Two patients had diffuse cystic bronchiectasis, and neither reported a history of illness that may have predisposed them to this condition.Bronchiectasis may be more common in patients with alpha 1-antitrypsin deficiency than has been previously recognized. The diagnosis of alpha 1-antitrypsin deficiency should be considered in patients with emphysema and diffuse cystic bronchiectasis.
Alpha 1-antitrypsin deficiency
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To describe the range and frequency of abnormalities on computed tomographic (CT) scans in patients who met the American Thoracic Society (ATS) case definition of Mycobacterium avium complex (MAC) lung disease. Further, to report the effect of time and treatment on the progression of these abnormalities.The demographic, clinical and radiologic features of 10 patients with proven MAC lung disease (mean age 71 years, standard deviation 12 years) were described. The presence or absence of 14 CT abnormalities was recorded in each of 10 lung zones. The effects of time and treatment on the abnormalities were recorded.The patients' lung function was minimally impaired. Pretreatment CT scans showed small nodules in 47% of the lung zones, reduced lung attenuation in 41%, and bronchiectasis in 27%. Bronchiectasis was associated with nodules in 20 zones from 9 patients and with no nodules in 7 zones from 1 patient. Reduced attenuation was associated with bronchiectasis alone in 8 zones, with nodules alone in 25 zones and with both bronchiectasis and nodules in 8 zones. In patients without treatment, or with non-curative treatment, bronchiectasis developed or worsened in 12 of 26 zones and resolved or improved in none. In contrast, after curative treatment, small nodules disappeared completely in 10 of 21 zones and developed in none. Of 7 zones with only nodules and reduced attenuation before treatment, 6 had no abnormalities after treatment.Our data suggest that the 3 leading CT abnormalities in nodular-bronchiectatic MAC lung disease are small nodules, reduced attenuation and bronchiectasis. Reduced attenuation appeared to result from gas trapping and hypoxic vasoconstriction due to bronchiolocentric inflammatory nodules. Bronchiectasis appeared to be secondary to this bronchiolar disease.
Mycobacterium avium complex
Nodule (geology)
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Pr. Med. 1932, 15. Em. Sergent distinguishes 3 types iosologically:
abscessing bronchiectasis (where abscess formation or gangrenization occurs during former bronchiectasis);
oronchiectasis abscesses (where bronchiectasis is complicated secondarily);
abcs bronchiectasiques (where abscess and bronchiectasis develop simultaneously).
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Nontuberculous Mycobacteria
Mycobacterium avium complex
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Objective To explore whether the bronchiectasis accompany bronchial asthma exist and its clinical characteristics. Methods (1) For 84 cases of bronchiectasis of patients which confirmed by clinical diagnosis applied bronchial provocation test and clinical dilatation test. Selected the cases of bronchiectasis accompany asthma and pure bronchiectasis. (2) For this two types performed detailed guestionnaire of former disease history. (3) For this two types performed clinical observation. (4) The type of bronchiectasis accompany asthma was divided into two groups. Group A and group B, performed experiment treatment according different projects. Results (1) 81 cases of patients with bronchiectasis performed bronchial provocation test among 16 cases were positive (PD20 FEV112.8u mol), 3 cases of patients with bronchiectasis performed bronchial dilatation test among 2 cases where positive (FEV increase range15%). These 18 cases were confirmed diagnosis to bronchiectasis accompany asthma, another 66 cases of patients with bronchiectasis were belong to pure bronchiectasis. (2) In bronchiectasis accompany asthma, the frequency of personal allergic disease history and family allergic history was very high, respectively 106% and 111%, but in pure bronchiectasis, the frequency was very low, only 9% and 6%. (3) In bronchiectasis accompany asthma, attack symptoms often were increase heavy seasonly, and frequently there were allergic symptoms in the upper respiratory tract, all of cases of patients contained diffuse wheezing or focal wheezing in the lung. (4) Bronchiectasis accompany asthma divided group experiment treatment. Group A used anti bronchiectasis and anti asthma medicine. The treatment effect showed marked, fundamental completely cure. But group B only used anti bronchiectasis medicine, a large cases leaved symptom and sign. Conclusions Bronchiectasis accompany asthma is a special type, which may be difference from the pure bronchiectasis through the examination of bronchial provocation test and bronchial dilatation test, asking the former disease history and experiment treatment. Project of its treatment different from pure bronchiectasis.
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Background
Bronchiectasis, with was once thought to be an orphan disease, is now being recognized with increasing frequency around the world. Patients with bronchiectasis have chronic cough and sputum production, and bacterial infections develop in that result in the loss of lung function. Bronchiectasis occurs in patients across the spectrum of age and gender, but the highest prevalence is in older women. The diagnosis of bronchiectasis is made by high-resolution CT scans. Bronchiectasis, which can be focal or diffuse, may occur without antecedent disease but is often a complication of previous lung infection or injury or is due to underlying systemic illnesses. Patients with bronchiectasis may have predisposing congenital disease, immune disorders, or inflammatory disease. The treatment of bronchiectasis is multimodality, and includes therapy with antibiotics, anti-inflammatory agents, and airway clearance. Resectional surgery and lung transplantation are rarely required. The prognosis for patients with bronchiectasis is variable given the heterogeneous nature of the disease. A tailored, patient-focused approach is needed to optimally evaluate and treat in individuals with bronchiectasis. Bronchiectasis is destruction and widening of the large airways. If the condition is present at birth, it is called congenital bronchiectasis.
Chest physiotherapy
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The author examined computed tomographic (CT) scans of the chest from 40 patients with cultures positive for atypical mycobacteria. Common manifestations included bronchiectasis, air-space disease, nodules, and scarring and/or volume loss. Less commonly observed signs were cavities, lymphadenopathy, and pleural disease. Serial scans were obtained in 10 patients and showed new areas of bronchiectasis and progression of existing bronchiectasis, suggesting that the bronchiectasis was not a preexisting condition but resulted from infection. The anatomic distribution of the above findings was diffuse, not strongly favoring any lung zone. The identification of multifocal coexistent bronchiectasis, air-space disease, and nodules at CT should raise the possibility of atypical mycobacterial lung disease, even in an otherwise healthy patient.
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