Document Detail


Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome.
MedLine Citation:
PMID:  18703788     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: Pulmonary nontuberculous mycobacterial (PNTM) disease is increasing, but predisposing features have been elusive.
OBJECTIVES: To prospectively determine the morphotype, immunophenotype, and cystic fibrosis transmembrane conductance regulator genotype in a large cohort with PNTM.
METHODS: We prospectively enrolled 63 patients with PNTM infection, each of whom had computerized tomography, echocardiogram, pulmonary function, and flow cytometry of peripheral blood. In vitro cytokine production in response to mitogen, LPS, and cytokines was performed. Anthropometric measurements were compared with National Health and Nutrition Examination Survey (NHANES) age- and ethnicity-matched female control subjects extracted from the NHANES 2001-2002 dataset.
MEASUREMENTS AND MAIN RESULTS: Patients were 59.9 (+/-9.8 yr [SD]) old, and 5.4 (+/-7.9 yr) from diagnosis to enrollment. Patients were 95% female, 91% white, and 68% lifetime nonsmokers. A total of 46 were infected with Mycobacterium avium complex, M. xenopi, or M. kansasii; 17 were infected with rapidly growing mycobacteria. Female patients were significantly taller (164.7 vs. 161.0 cm; P < 0.001) and thinner (body mass index, 21.1 vs. 28.2; P < 0.001) than matched NHANES control subjects, and thinner (body mass index, 21.1 vs. 26.8; P = 0.002) than patients with disseminated nontuberculous mycobacterial infection. A total of 51% of patients had scoliosis, 11% pectus excavatum, and 9% mitral valve prolapse, all significantly more than reference populations. Stimulated cytokine production was similar to that of healthy control subjects, including the IFN-gamma/IL-12 pathway. CD4(+), CD8(+), B, and natural killer cell numbers were normal. A total of 36% of patients had mutations in the cystic fibrosis transmembrane conductance regulator gene.
CONCLUSIONS: Patients with PNTM infection are taller and leaner than control subjects, with high rates of scoliosis, pectus excavatum, mitral valve prolapse, and cystic fibrosis transmembrane conductance regulator mutations, but without recognized immune defects.
Authors:
Richard D Kim; David E Greenberg; Mary E Ehrmantraut; Shireen V Guide; Li Ding; Yvonne Shea; Margaret R Brown; Milica Chernick; Wendy K Steagall; Connie G Glasgow; JingPing Lin; Clara Jolley; Lynn Sorbara; Mark Raffeld; Suvimol Hill; Nilo Avila; Vandana Sachdev; Lisa A Barnhart; Victoria L Anderson; Reginald Claypool; Dianne M Hilligoss; Mary Garofalo; Alan Fitzgerald; Sandra Anaya-O'Brien; Dirk Darnell; Rosamma DeCastro; Heather M Menning; Stacy M Ricklefs; Stephen F Porcella; Kenneth N Olivier; Joel Moss; Steven M Holland
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Publication Detail:
Type:  Journal Article     Date:  2008-08-14
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  178     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-06     Completed Date:  2008-12-16     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1066-74     Citation Subset:  AIM; IM    
Affiliation:
Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892-1684, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Body Height
Case-Control Studies
Cystic Fibrosis Transmembrane Conductance Regulator / genetics
Female
Funnel Chest / complications
Humans
Male
Middle Aged
Mutation
Mycobacterium Infections, Nontuberculous / etiology*,  genetics,  immunology
Phenotype
Pneumonia, Bacterial / etiology*
Prospective Studies
Risk Factors
Scoliosis / complications
Sex Factors
Smoking / adverse effects
Syndrome
Thinness / complications
Chemical
Reg. No./Substance:
126880-72-6/Cystic Fibrosis Transmembrane Conductance Regulator
Comments/Corrections
Comment In:
Am J Respir Crit Care Med. 2009 Jun 15;179(12):1165; author reply 1165   [PMID:  19498065 ]
Am J Respir Crit Care Med. 2008 Nov 15;178(10):999-1000   [PMID:  18987345 ]

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