| Objective To investigate the clinical characteristics and imaging findings of nontuberculous mycobacterial lung infection in a comprehensive hospital.Methods We retrospectively reviewed the cases diagnosed with NTM lung diseases between January 2015 and December 2020 at Fujian Provincial Hospital,and collected data on the baseline patient population,clinical manifestations,laboratory tests,and imaging findings.Results A total of 79 patients were identified with NTM lung disease,40 males and 39 females,with a male to female ratio close to 1:1.The age stratum was dominated by those over 50 years old,with the age group 51-65 years being the most prevalent(37/79,46.8%).Lang-term use of inhaled glucocorticoids was recorded in 11 cases,oral or intravenous glucocorticoids in 6 cases,and immunosuppressive agents(except glucocorticoids)in 6 cases.Seventy patients(88.5%)had associated chronic underlying diseases,most frequently bronchiectasis(44/79,55.7%),followed by diabetes(10/79,12.8%),COPD(8/79,10.1%),bronchial asthma(7/79,9.0%),and previous history of tuberculosis(7/79,9.0%).Cough(69/79,87.3%)and expectoration(61/79,77.2%)were the first clinical manifestations in 79 patients,followed by fever(22/79,27.8%),hemoptysis(19/79,24.1%),and weight loss(8/79,10.1%).Regarding laboratory tests,the median values of procalcitonin,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and NAP scores were 0.065,11.4,30.0,and 105.5.Except pracalcitonin was within normal reference values respectively,other three indicators were mildly elevated compared with normal values.The median number of absolute CD45+T lymphocyte count indicators was 1094.0,which was lower than the normal reference value.The positive acid fast staining rate of respiratory samples was 32/79(40.5%),of which sputum acid fast staining rate was lower,only 15/79(19.0%).The distribution of radiographic changes in NTM lung disease was more variable with simultaneous involvement of both lungs(53/79,67.1%).The radiographic changes were mostly characterized by patchy cord like opacities(68/79,86.1%),nodules(51/79,64.6%),consolidation(46/79,58.2%),bronchiectasis(46/79,58.2%),globular/clumped opacities(9/79,11.4%),honeycombing(11/79,13.9%),cavitation(12/79,15.2%),calcifications(14/79,17.7%)while other manifestations were rare.The 79 patients could be divided into one-lung infection group(n=26)or two-lung infection group(n=53)based on the extent of lesion involvement on imaging studies,and the p-values were calculated by comparing the two groups’ population baseline data,laboratory findings(including white blood cell count,procalcitonin,C-reactive protein,erythrocyte sedimentation rate,NAP score,and other immune related indicators such as absolute values of peripheral T-lymphocytes).All P values of them were more than 0.05 which no significant difference was found.Comparing the imaging findings between the two groups,we found that the three imaging changes including nodules,tree bud sign and pleural thickening tended to distribute symmetrically in the two lungs(chi square test χ2=9.251,P=0.002;χ2=23.989,P=0.000;χ2=3.891,P=0.049).All P values of them were less than 0.05.Conclusion NTM lung disease has no typical features in terms of clinical presentation,laboratory and imaging findings.For patients who present to a general hospital with a chronic lung disease basis such as bronchiectasis,decreased systemic or local immunity in the lung,and whose chest imaging examination is dominated by multiple nodules,patchy cords,solid changes,or bronchiectasis,clinical suspicion of tuberculosis and in anti-tuberculosis treatment is ineffective,high vigilance is required for developing NTM lung disease as a possibility.Genetic testing can assist in an early and rapid prompt diagnosis and treatment.A total of 39 NTM isolates were identified by mNGS.Ten species of NTM were classified mainly including M.abscessus(n=7,24.1%),M.intracellulare(n=6,2 0.7%),Mcolombiense(n=4,13.8%),M.avium(n=3,10.3%),M.paraintracellulare(n=3,10.3%)and other NTM species(n=5,17.2%). |
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