Micobactérias atípicas em doentes sem síndroma de imunodeficiência adquirida

 

 A Marinho ¹

G Fernandes ¹

T Carvalho ²

D Pinheiro ²

I Gomes ¹

 

 

Resumo

As micobactérias não tuberculosas (MNT) têm um papel patogénico de importância crescente em doentes com serologia positiva para o vírus da imunodeficiência humana (VIH), em doentes com doença pulmonar crónica, em outras doenças crónicas, e ainda nos idosos.

Objectivo: Avaliar a importância do isolamento de MNT em amostras respiratórias em doentes adultos sem infecção VIH.

Material e métodos: Estudo retrospectivo dos doentes do Hospital de São João sem infecção VIH conhecida, com pelo menos uma amostra respiratória positiva para MNT, entre 1997 e 2004.

Resultados: Foram encontrados 102 doentes com idade mediana de 63 anos; 67% do sexo masculino. Sessenta e três doentes (62%) apresentavam patologia respiratória prévia, maioritariamente sequelas de tuberculose pulmonar (n=19). O agente mais isolado (47%) foi o Mycobacterium avium complex (MAC). Foram identificados 16 casos de doença (15,7%), 14 dos quais cumpriam os critérios definidos pela American Thoracic Society. Dez homens e 6 mulheres, idade mediana de 65 anos. Doze doentes tinham doença pulmonar prévia. Todos tinham clínica de infecção respiratória. As alterações mais observadas no Rx de tórax foram o infiltrado pulmonar, a opacidade linear e a cavitação. O MAC foi o causador de doença em 75% (n=12) dos casos.

Conclusão: O isolamento de micobactérias atípicas em amostras respiratórias, nomeadamente em doentes com patologia pulmonar prévia, não significou doença na grande maioria dos casos, mesmo em doentes com doença pulmonar prévia. O agente mais frequentemente isolado foi o MAC, tendo a sua importância relativa sido ainda maior nos casos de doença pulmonar por MNT.

Palavras -chave: Micobactérias atípicas, isolamento, doença pulmonar.

 

 

Nontuberculous mycobacteria in non-AIDS patients

Nontuberculous mycobacteria (NTM) play an increasingly significant pathogenic role in HIV –positive patients, in patients with chronic lung disease, in other chronic conditions and in the elderly.

Aims: Evaluate the importance of NTM isolation in respiratory samples in patients without HIV-infection.

Methods: Retrospective evaluation of our hospital patients with no known AIDS, with at least one NTM positive respiratory sample, from 1997 -2004.

Results: We found 102 patients, with a median age of 63 years; 67% male. Sixty -three (62%) had underlying lung disease, mainly tuberculosis sequelae (n=19). The majority (47%) of the isolations were Mycobacterium avium complex (MAC). A diagnosis of Mycobacterium pulmonary disease was made in 16 patients (15.7%), 14 of which met the American Thoracic Society diagnostic criteria. Ten male and 6 female; median age 65 years. Twelve had underlying lung disease. All of them had respiratory infection complaints. Chest X -rays showed mainly pulmonary infiltrates, linear opacities and cavitation. MAC was the cause of mycobacterium respiratory disease in 12 patients (75%).

Conclusion: NTM isolation did not equal pulmonary NTM disease in the majority of cases, even in patients with underlying lung disease. MAC was the most commonly isolated agent and its relative importance was higher in the presence of NTM disease.

Key-words: Nontuberculous mycobacteria, isolation, pulmonary disease.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

Bibliografia / Bibliography

1. Subcommittee of Joint Tuberculosis Committee of British Thoracic Society. Management of opportunist mycobacterial infection. Thorax 2000; 55:210 -18.

2. Henry MT, Inamdar L, O`Riordain D, Schweiger M, Watson JP. Nontuberculous mycobacteria in non -HIV patients: epidemiology, treatment and response. Eur Respir J 2004; 23:741 -6.        [ Links ]

3. Timothy RA. Mycobacterium avium complex pulmonary disease in patients with pre -existing lung disease. Clin Chest Med 2002; 23:643 -53.

4. Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis 1979; 119: 107 -59.

5. Prince DS, Peterson DD, Steiner RM et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Eng J Med 1989; 321:863 -8.

6. Newport MJ, Huxley CM, Huston S, et al. A mutation in the interferon -γ -receptor gene and susceptibility to mycobacterial infection. N Engl J Med 1996; 335:1941 -9.

7. Dorman SE, Holland SM. Interferon -γ and interleukin -12 pathway defects and human disease. Cytokine Growth Factor Rev 2000; 11: 321 -33.

8. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. American Thoracic Society. Am J Respir Crit Care Med 1997; 156: S1 -S25.

9. Daley L Charles, Griffith E David. Pulmonary disease caused by rapid growing mycobacteria. Clin Chest Med 2002; 23: 623 -32.

10. Kenneth N. Olivier, David J. Weber, Richard J. Wallace, et al. Nontuberculous Mycobacteria –Multicenter Prevalence Study in Cystic Fibrosis. Am J Respir Crit Care 2003; 167: 828 -34.

11. Esther CR Jr, Henry MM, Molina PL, et al. Nontuberculous mycobacterial infection in young children with cystic fibrosis. Pediatr Pulmonol 2005; 40:39 -44.

12. Pierre -Audigier C, Ferroni A, Sermet -Gaudelas I, et al. Age -related prevalence and distribution on nontuberculous mycobacterial species among patients with cystic fibrosis. J Clin Microbiol 2005; 43:3467 -70.

13. Barker AF. Bronchiectasis. N Engl J Med 2002; 346: 1383 -93.

14. Wickremasinghe M, Ozerovitch LJ, Davies G, et al. Nontuberculous mycobacteria in patients with bronchiectasis. Thorax 2005; 60:1048 -51.

15. Iseman MD, Buschman DL, Ackerson LM. Pectus excavatum and scoliosis: thoracic abnormalities associated with pulmonary disease caused by Mycobacterium avium complex. Am Rev Respir Dis 1991; 144: 914 -6.

16. Guide SV, Holland SM. Host susceptibility factors in mycobacterial infection: genetics and body morphotype. Infect Dis Clin North Am 2002; 16:163 -86.

17. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Disease. Am J Respir Crit Care Med 2007; 175: 367 -416.

18. Thomsen VO, Andersen AB, Miorner H. Incidence and clinical significance of non -tuberculous mycobacteria isolated from clinical specimens during a 2 -y nationwide survey. Scand J Infect Dis 2002; 34:648 -53.

19. Haverkort F. National atypical mycobacteria survey, 2000. Commun Dis Intel 2003; 27:180 -9.

20. Butler WR, Crawford JT. NTM reported to the public health laboratory information system by state public health laboratories United States 1993 -1996, July 1999. Available at: www.cdc.gov/ncidod/dastlr/mycobacteriology.htm. Accessed July 1, 2005. 21. Martin -Casabona N, Bahrmand AR, Bennedsen J, et al. Non -tuberculous mycobacteria: patterns of isolation: a multi -country retrospective survey. Int J Tuberc Lung Dis 2004; 8: 1186 -93.

22. Edwards LB, Palmer CE. Isolation of «atypical» mycobacteria from health persons. Am Rev Respir Dis 1959: 80:747 -9.

23. American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria; Am Rev Respir Dis 1990; 142:940 -53.

24. Stephen KF, Dina Fisher, Robert L Cowie. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Chest 2004; 126: 566 -81.

25. Thomas P Kennedy, David J Weber. Nontuberculous mycobacteria, an underappreciated cause of geriatric

lung disease. Am J Respir Crit Care Med 1994; 149: 1654 -8.

26. Judy H Huang, Peter N Kao, Virginia Adi, Stephen J Ruoss. Mycobacteruim avium -intracellulare Pulmonary Infection in HIV -negative Patients Without Preexisting Lung Disease. Chest 1999; 115:1033 -40.

27. Wittram C, Weisbrod G. Mycobacterium avium complex lung disease in immunocompetent patients: radiography -CT correlation. The British Journal of Radiology 2002; 75:340 -4.

28. Okada Y, Ichinose Y, Yamaguchi K, et al. Mycobacterium avium -intracellulare pleuritis with massive pleural effusion. Eur Respr J 1995; 8: 1428 -9.

29. Yanagihara K, Tomono K, Sawai T, et al. Mycobacterium avium Complex Pleuritis. Rspiration 2002; 69: 547 -9.

30. Levin DL. Radiology of pulmonary Mycobacterium avium -intracellulare complex. Clin Chest Med 2002; 23(3):603 -12.

31. Chalermskulrat W, Gilbey Jack, Donohue James. Nontuberculous mycobacterea in women, young and old. Clin Chest Med 2002; 23:675 -86.

32. Kubo Keishi, Yamazaki Yoshitaka, et al. Pulmonary infection with MAC leads to air trapping distal to the small airways. Am J Respir Crit Care Med 1998; 158: 979 -84.

 

 

1 Serviço de Pneumologia do HSJ (Director: Prof. Dr. J. Agostinho Marques), Porto, Portugal / Pulmonology Unit, Hospital São João, Oporto, Portugal

2 Serviço de Microbiologia do HSJ (Directora: Prof.ª Dr.ª MJ Vaz), Porto, Portugal / Microbiology Unit, Hospital São João, Oporto, Portugal

Hospital de São João, Alameda Hernâni Monteiro, 4200-Porto

 

 

Recebido para publicação/received for publication: 07.08.11

Aceite para publicação/accepted for publication: 08.01.07