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Nontuberculous Mycobacteria Lung Disease On The Rise In The United ...

Nontuberculous mycobacteria (NTM) are environmental organisms found in both water and soil that can cause severe pulmonary (lung) disease in humans. Pulmonary NTM is on the rise in the United States, according to a large study of people hospitalized with the condition.

A research team led by epidemiologists from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, analyzed hospital discharge records of patients in 11 states whose combined total population represents 42 percent of the country. They reviewed database records spanning 1998 to 2005, and identified more than 16,475 hospitalizations associated with pulmonary NTM in people without AIDS. Before the widespread availability of combination antiretroviral therapy, pulmonary NTM disease was a common opportunistic infection among people with AIDS infection; in this study, the researchers limited their analysis to non-AIDS NTM disease.

Of the 11 states studied, Florida, New York and California had 62 percent of the pulmonary NTM hospitalizations. The scientists chose these states to compare trends by geographic area. They found the annual prevalence of disease increased significantly among men and women in Florida (3.2 percent per year for men and 6.5 percent per year for women) and among women in New York (4.6 percent per year). There were no significant changes in California. Whether these geographic differences in prevalence are a result of exposure to NTM, or increased concentrations of mycobacterium in certain environments, or both, is not clear. However, previous studies have found high disease prevalence in the southeastern United States, particularly along the coastal regions of the Atlantic and Gulf coasts.

Study results show pulmonary NTM has increased in certain geographic areas of the United States, and while overall prevalence is higher in women, prevalence increases for both sexes in the fifth or sixth decade of life. Further research is needed to define the prevalence of the disease in nonhospitalized people in regions throughout the United States and to determine risk factors for disease susceptibility, including genetic and environmental factors.

GERD Linked To Nontuberculous Mycobacteria Pulmonary Disease ... - Healio

April 19, 2023

2 min read

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Key takeaways:

Nontuberculous mycobacteria pulmonary disease occurred in more patients with GERD.

Risk factors for this disease included being at least 60 years old and having bronchiectasis.

Patients with GERD experienced more incidences of nontuberculous mycobacteria pulmonary disease than patients without GERD, according to study results published in CHEST.

"GERD was shown to be an important predisposing factor for the development of nontuberculous mycobacteria pulmonary disease, and older age and bronchiectasis were risk factors for incident nontuberculous mycobacteria pulmonary disease in patients with GERD," Youlim Kim, MD, PhD, of the division of pulmonary, allergy and critical care medicine at Konkuk University School of Medicine, and colleagues wrote. "Nontuberculous mycobacteria pulmonary disease developing in patients with GERD is associated with increased health care use."

Data were derived from Kim Y, et al. CHEST. 2023;doi:10.1016/j.Chest.2022.08.2228.

In a population-based longitudinal cohort study, Kim and colleagues analyzed 17,424 adults with GERD (26.3% aged 50 to 59 years; 50.1% men) between 2002 and 2015 from the Korean National Health Insurance Service National Sample Cohort to determine if GERD plays a role in nontuberculous mycobacteria pulmonary disease development. They also sought to identify risk factors linked to nontuberculous mycobacteria pulmonary disease in this patient population and how the prevalence of ED/hospital visits changes with the disease.

Using age, sex, insurance type and Charlson Comorbidity Index variables, researchers matched GERD patients with control patients (n = 69,696; 26.3% aged 50 to 59 years; 50.1% men) to assess differences in the two cohorts. The median follow-up period was 5.1 years.

When assessing incidence rates after adjusting for age and sex, patients with GERD showed more instances of nontuberculous mycobacteria pulmonary disease vs. Control patients (34.8 per 100,000 patient-years vs. 10.5 per 100,000 patient-years).

Assessment against matched patients further showed a 3.4-fold (subdistribution HR = 3.36; 95% CI, 2.1-5.37) higher risk for nontuberculous mycobacteria pulmonary disease in patients with GERD, according to researchers.

For factors linked to a heightened risk for nontuberculous mycobacteria pulmonary disease among patients with GERD, researchers identified two during univariate and multivariate analysis: age of at least 60 years (aHR = 3.57; 95% CI, 1.58-8.07) and bronchiectasis (aHR = 18.69; 95% CI, 6.68-52.28).

Additionally, patients with GERD and nontuberculous mycobacteria pulmonary disease had more instances of all-cause ED/hospital visits than patients with GERD and no further disease (13,321 per 100,000 patient-years vs. 5,932 per 100,000 patient-years; P = .049). More specifically, patients with both diseases also had a greater number of respiratory disease-related ED/hospital visits (5,403 per 100,000 patient-years vs. 801 per 100,000 patient-years; P = .011).

With these findings, Kim and colleagues brought attention to three possible clinical implications.

"First, because the risk of nontuberculous mycobacteria pulmonary disease in patients with GERD was significantly higher than in those without GERD, nontuberculous mycobacteria pulmonary disease should be suspected when new-onset or worsening of respiratory symptoms develop during regular follow-up in patients with GERD," Kim and colleagues wrote. "Second, because the results indicate that older age and bronchiectasis significantly increased the risk of nontuberculous mycobacteria pulmonary disease, more active strategies (eg, screening of symptoms and regular chest radiography follow-up) may be helpful in patients with GERD and these risk factors.

"Third, patients with GERD who demonstrated nontuberculous mycobacteria pulmonary disease made more respiratory disease-related ED visits and were hospitalized more often than those who did not demonstrate nontuberculous mycobacteria pulmonary disease," they added. "Thus, when GERD and nontuberculous mycobacteria pulmonary disease are combined, clinicians should focus on the variations of respiratory symptoms."

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Hospitalization Burden High In Adults With Nontuberculous Mycobacterial ...

August 17, 2021

2 min read

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Older adults with nontuberculous mycobacterial pulmonary disease have significantly greater likelihood for hospitalization, higher hospitalization rates and shorter time to hospitalization than those without, researchers reported.

"The risk of hospitalization among persons with nontuberculous mycobacterial pulmonary disease demonstrates a very high burden of disease and associated morbidity," D. Rebecca Prevots, PhD, MPH, chief of the Epidemiology and Population Studies Unit at the NIH, and colleagues wrote in Chest. "Hospitalizations are associated with an increased cost relative to outpatient care, and an improved understanding of the risk of hospitalization attributable to nontuberculous mycobacterial pulmonary disease will allow for a better estimation of the associated costs."

Source: Adobe Stock.

The retrospective, nested, case-control study included 35,444 patients (mean age, 76.6 years; 69.8% women) aged 65 years and older with two or more nontuberculous mycobacterial pulmonary disease claims at least 30 days apart from 2007 to 2015 in the Medicare claims database. All individuals were continuously enrolled in Medicare Parts A and B at least 12 months before their first nontuberculous mycobacterial pulmonary disease diagnosis. These cases were compared with 65,467 age- and sex-matched controls (mean age, 76.6 years; 70.8% women).

Patients with nontuberculous mycobacterial pulmonary disease had more comorbidities at baseline compared with controls, including COPD (81.1% vs. 17.7%; P < .001) and bronchiectasis (44.6% vs. 0.6%; P < .001).

The rate of all-cause hospitalization was 65.7% for patients with nontuberculous mycobacterial pulmonary disease compared with 44.9% for controls.

Annual hospitalization rates were significantly greater among patients with nontuberculous mycobacterial pulmonary disease: all-cause hospitalization (incidence rate ratio [IRR] = 1.79; 95% CI, 1.77-1.81), COPD-related hospitalization (IRR = 5.83; 95% CI, 5.64-6.02), pneumonia-related hospitalization (IRR = 4.92; 95% CI, 4.75-5.1) and other pulmonary disease-related hospitalization (IRR = 4.16; 95% CI, 3.75-4.61).

Time to all-cause hospitalization was a median of 191 days for patients with nontuberculous mycobacterial pulmonary disease compared with 448 days among controls.

In addition, patients with nontuberculous mycobacterial pulmonary disease were one to two times more likely to be hospitalized (RR = 1.23; 95% CI, 1.21-1.25; P < .0001) and had a 46% higher risk for all-cause hospitalization compared with controls (HR = 1.46; 95% CI, 1.43-1.5; P < .0001).

"Patients with nontuberculous mycobacterial pulmonary disease aged > 65 years had statistically significantly more hospitalizations compared with age- and sex-matched control subjects without nontuberculous mycobacterial pulmonary disease, highlighting the need for careful medical management of these patients and the need for clinical management strategies that may reduce excess hospitalizations for these patients," the researchers wrote.

Sources/DisclosuresCollapse Disclosures: The study was sponsored by Insmed Inc. Prevots reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.

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