Original Articles
Nontuberculous Mycobacterial Infection in Patients With Cystic Fibrosis: A Multicenter Prevalence Study
Rosa M. Giróna,
, Luis Máizb, Isabel Barrioc, M. Teresa Martínezd, Antonio Salcedoe, Concepción Pradosc
Corresponding author
med002861@nacom.es
Correspondence: Dr R.M. Girón Moreno Servicio de Neumología, Hospital de la Princesa Diego de León, 62, 28006 Madrid, Spain
Correspondence: Dr R.M. Girón Moreno Servicio de Neumología, Hospital de la Princesa Diego de León, 62, 28006 Madrid, Spain
a Unidad de Fibrosis Quística, Hospital de la Princesa, Madrid, Spain
b Unidad de Fibrosis Quística, Hospital Ramón y Cajal, Madrid, Spain
c Unidad de Fibrosis Quística, Hospital La Paz, Madrid, Spain
d Unidad de Fibrosis Quística, Hospital 12 de Octubre, Madrid, Spain
e Unidad de Fibrosis Quística, Hospital Materno-Infantil del Gregorio Marañón, Madrid, Spain
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Girón Moreno Servicio de Neumología, Hospital de la Princesa Diego de León, 62, 28006 Madrid, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-10-29" "fechaAceptado" => "2008-04-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155134" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Cystic fibrosis</span>" 1 => "<span class="elsevierStyleItalic">Nontuberculous mycobacteria</span>" 2 => "<span class="elsevierStyleItalic">Mycobacterium avium</span>" 3 => "<span class="elsevierStyleItalic">Mycobacterium abscessus</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155135" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Fibrosis quística</span>" 1 => "<span class="elsevierStyleItalic">Micobacterias ambientales</span>" 2 => "<span class="elsevierStyleItalic">Mycobacterium avium</span>" 3 => "<span class="elsevierStyleItalic">Mycobacterium abscessus</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of nontuberculous mycobacterial infection in patients with cystic fibrosis.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a prospective study in which patients with cystic fibrosis were followed for 2 years; the patients were recruited from specialized units and were all over 6 years old. Sputum samples collected every 6 months were stained with auramine-rhodamine and cultures were prepared with a liquid and a solid medium. When stains or cultures were positive for nontuberculous mycobacteria, 1 or 2 additional sputum samples were obtained from the patients, who were monitored closely to assess the need for specific treatment. We assessed the following clinical variables: age, sex, presence of pancreatic insufficiency, use of aerosol antibiotic therapy, and long-term azithromycin and inhaled or oral corticosteroid therapies.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 220 patients (119 women) with a mean age of 22.62 years (range, 6-74 years) were enrolled; of these23.6% were receiving azithromycin. We prepared 1303 sputum samples for mycobacterial growth (range per patient, 4-68 samples); 65 samples from a total of 17 patients(7.72%) were positive: 17 by auramine-rhodamine staining and 48 by culture. Eighty-eight culture samples were contaminated and <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> was not isolated in any of the cases. The mycobacteria isolated were <span class="elsevierStyleItalic">avium complex</span> (n=10), <span class="elsevierStyleItalic">abscessus</span> (n=6), and <span class="elsevierStyleItalic">fortuitum</span> (n=1). Two or more positive cultures were obtained in 9 patients, 5 of whom experienced clinical deterioration and were prescribed specific treatment. No significant differences in clinical variables were found between patients with nontuberculous mycobacteria and those without.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The prevalence of nontuberculous mycobacterial infection in patients with cystic fibrosis was not very high (7.72%), perhaps because azithromycin interfered with the growth of these bacteria. Patients with repeat isolations of mycobacteria should be monitored closely.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluar la prevalencia de micobacterias ambientales (MA) en pacientes con fibrosis quística (FQ).</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio prospectivo de 2 años de duración en pacientes con FQ mayores de 6 años, procedentes de 6 unidades monográficas. En las muestras respiratorias, recogidas cada 6 meses, se efectuó una tinción de auramina-rodamina, además de cultivos en medios sólido y líquido. Si se detectaba una tinción o cultivo positivo para MA, se recogían 1 o 2 esputos más y se hacía un seguimiento estricto para valorar la necesidad de tratamiento específico. Se consideraron las siguientes variables clínicas: edad, sexo, insuficiencia pancreática, diabetes, uso de aerosolterapia antibiótica y de azitromicina de forma continua, tratamientos con corticoides inhalados o por vía oral de forma prolongada.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Participaron en el estudio 220 pacientes (119 mujeres), con una edad media de 22,62 años (rango: 6-74). El 24% recibía azitromicina. Se cultivaron para la detección de micobacterias 1.303 muestras de esputo (rango por paciente: 4-68), de las que la tinción de auramina fue positiva en 17 casos y el cultivo en 48, correspondientes a 17 pacientes (7,72%). En 88 muestras el cultivo estaba contaminado. En ningún caso se aisló <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>. Las MA aisladas fueron: <span class="elsevierStyleItalic">M. avium complex</span> (n = 10)<span class="elsevierStyleItalic">, M. abscessus</span> (n = 6) y <span class="elsevierStyleItalic">M. fortuitum</span> (n = 1). Cinco de los 9 pacientes que presentaron más de un aislamiento tuvieron deterioro clínico y se les indicó tratamiento específico. No hubo diferencias entre las variables clínicas de los pacientes con y sin aislamientos de MA.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La prevalencia de MA en pacientes con FQ no fue muy alta (7,72%), quizá debido a la interferencia de la azitromicina sobre el crecimiento de MA. Hay que vigilar estrechamente a los pacientes con aislamientos repetidos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Newborn screening for cystic fibrosis: the practical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "KW Southern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J R Soc Med" "fecha" => "2004" "volumen" => "97" "paginaInicial" => "57" "paginaFinal" => "59" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15239296" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology and management of pulmonary infection in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R Gibson" 1 => "J Burns" 2 => "B Ramsey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200304-505SO" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2003" "volumen" => "168" "paginaInicial" => "918" "paginaFinal" => "951" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14555458" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Cystic Fibrosis Foundation" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Patient Registry Annual Data Report 2006" "fecha" => "2008" "editorial" => "CYF" "editorialLocalizacion" => "Bethesda, Maryland" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patógenos multirresistentes en la fibrosis quística" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R Cantón" 1 => "RM Girón" 2 => "L Martínez-Martínez" 3 => "A Oliver" 4 => "A Solé" 5 => "S Valdezate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "376" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12199920" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nontuberculous mycobacteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "SM Holland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med Sci" "fecha" => "2001" "volumen" => "321" "paginaInicial" => "49" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11202480" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Griffith D, Walace R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 48 | 17 | 65 |
| 2024 September | 29 | 13 | 42 |
| 2024 August | 48 | 36 | 84 |
| 2024 July | 36 | 17 | 53 |
| 2024 June | 26 | 38 | 64 |
| 2024 May | 36 | 24 | 60 |
| 2024 April | 16 | 23 | 39 |
| 2024 March | 21 | 14 | 35 |
| 2024 February | 17 | 21 | 38 |
| 2023 March | 3 | 4 | 7 |
| 2023 February | 16 | 15 | 31 |
| 2023 January | 16 | 26 | 42 |
| 2022 December | 21 | 25 | 46 |
| 2022 November | 15 | 20 | 35 |
| 2022 October | 25 | 25 | 50 |
| 2022 September | 16 | 22 | 38 |
| 2022 August | 25 | 37 | 62 |
| 2022 July | 19 | 42 | 61 |
| 2022 June | 15 | 39 | 54 |
| 2022 May | 18 | 37 | 55 |
| 2022 April | 14 | 30 | 44 |
| 2022 March | 16 | 34 | 50 |
| 2022 February | 13 | 27 | 40 |
| 2022 January | 15 | 30 | 45 |
| 2021 December | 15 | 48 | 63 |
| 2021 November | 14 | 43 | 57 |
| 2021 October | 22 | 54 | 76 |
| 2021 September | 12 | 59 | 71 |
| 2021 August | 13 | 26 | 39 |
| 2021 July | 10 | 32 | 42 |
| 2021 June | 9 | 24 | 33 |
| 2021 May | 16 | 32 | 48 |
| 2021 April | 20 | 42 | 62 |
| 2021 March | 19 | 22 | 41 |
| 2021 February | 16 | 21 | 37 |
| 2021 January | 5 | 13 | 18 |
| 2020 December | 10 | 18 | 28 |
| 2020 November | 8 | 10 | 18 |
| 2020 October | 4 | 6 | 10 |
| 2020 September | 4 | 4 | 8 |
| 2020 August | 10 | 14 | 24 |
| 2020 July | 15 | 14 | 29 |
| 2020 June | 10 | 3 | 13 |
| 2020 May | 9 | 17 | 26 |
| 2020 April | 21 | 17 | 38 |
| 2020 March | 15 | 12 | 27 |
| 2020 February | 15 | 18 | 33 |
| 2020 January | 15 | 11 | 26 |
| 2019 December | 17 | 15 | 32 |
| 2019 November | 11 | 11 | 22 |
| 2019 October | 10 | 7 | 17 |
| 2019 September | 6 | 3 | 9 |
| 2019 August | 9 | 8 | 17 |
| 2019 July | 12 | 23 | 35 |
| 2019 June | 12 | 15 | 27 |
| 2019 May | 17 | 6 | 23 |
| 2019 April | 10 | 14 | 24 |
| 2019 March | 14 | 14 | 28 |
| 2019 February | 23 | 11 | 34 |
| 2019 January | 16 | 9 | 25 |
| 2018 December | 13 | 9 | 22 |
| 2018 November | 14 | 14 | 28 |
| 2018 October | 22 | 13 | 35 |
| 2018 September | 22 | 10 | 32 |
| 2018 May | 6 | 0 | 6 |
| 2018 April | 5 | 6 | 11 |
| 2018 March | 5 | 8 | 13 |
| 2018 February | 7 | 9 | 16 |
| 2018 January | 2 | 8 | 10 |
| 2017 December | 5 | 7 | 12 |
| 2017 November | 5 | 12 | 17 |
| 2017 October | 2 | 10 | 12 |
| 2017 September | 4 | 5 | 9 |
| 2017 August | 6 | 9 | 15 |
| 2017 July | 1 | 3 | 4 |
| 2017 June | 10 | 21 | 31 |
| 2017 May | 5 | 4 | 9 |
| 2017 April | 1 | 2 | 3 |
| 2017 March | 3 | 13 | 16 |
| 2017 February | 3 | 4 | 7 |
| 2017 January | 4 | 3 | 7 |
| 2016 December | 1 | 9 | 10 |
| 2016 November | 7 | 12 | 19 |
| 2016 October | 7 | 14 | 21 |
| 2016 September | 5 | 2 | 7 |
| 2016 August | 11 | 3 | 14 |
| 2016 July | 7 | 0 | 7 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 57 | 7 | 64 |
| 2015 September | 66 | 6 | 72 |
| 2015 August | 40 | 6 | 46 |
| 2015 July | 46 | 9 | 55 |
| 2015 June | 46 | 3 | 49 |
| 2015 May | 54 | 6 | 60 |
| 2015 April | 37 | 9 | 46 |
| 2015 March | 47 | 8 | 55 |
| 2015 February | 37 | 5 | 42 |
| 2015 January | 52 | 5 | 57 |
| 2014 December | 45 | 7 | 52 |
| 2014 November | 43 | 6 | 49 |
| 2014 October | 44 | 7 | 51 |
| 2014 September | 42 | 5 | 47 |
| 2014 August | 46 | 10 | 56 |
| 2014 July | 35 | 9 | 44 |
| 2014 June | 59 | 4 | 63 |
| 2014 May | 56 | 10 | 66 |
| 2014 April | 54 | 4 | 58 |
| 2014 March | 59 | 12 | 71 |
| 2014 February | 51 | 12 | 63 |
| 2014 January | 33 | 5 | 38 |
| 2013 December | 55 | 8 | 63 |
| 2013 November | 36 | 4 | 40 |
| 2013 October | 43 | 16 | 59 |
| 2013 September | 55 | 7 | 62 |
| 2013 August | 51 | 8 | 59 |
| 2013 July | 52 | 10 | 62 |
| 2013 June | 42 | 6 | 48 |
| 2013 May | 53 | 5 | 58 |
| 2013 April | 21 | 5 | 26 |
| 2013 March | 8 | 3 | 11 |
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