Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan - 23/05/19

Doi : 10.1016/j.rmed.2019.05.001

Koji Furuuchi ^a, Kozo Morimoto ^a,^b,^⁎ , Takashi Yoshiyama ^a, Yoshiaki Tanaka ^a, Keiji Fujiwara ^a, Masao Okumura ^a, Kiyohiko Izumi ^c, Yuji Shiraishi ^a, Satoshi Mitarai ^d, Hideo Ogata ^a, Atsuyuki Kurashima ^a, Kozo Yoshimori ^a, Ken Ohta ^a, Hajime Goto ^a, Yuka Sasaki ^a
^a Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
^b Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
^c Department of Epidemiology and Clinical Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
^d Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan

^∗Corresponding author. Department of Respiratory Medicine, Fukujuji Hospital Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo, 204-8522, Japan.Department of Respiratory MedicineFukujuji Hospital Japan Anti-Tuberculosis Association3-1-24MatsuyamaKiyoseTokyo204-8522Japan

Abstract

Background and objectives

The incidence of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing, while that of tuberculosis (TB) is decreasing in many industrialized countries, including Japan. However, the long-term evaluation of clinico-epidemiological features of NTM-PD in relation to TB are limited. We aimed to clarify the long-term changes in the epidemiology and clinical features of NTM-PD in relation to those of TB at a nationally-designated TB center in Japan.

Methods

We reviewed all mycobacterial examination records at Fukujuji Hospital between 2006 and 2016. Cases of NTM-PD were defined according to the 2007 American Thoracic Society/Infectious Disease Society of America microbiologic criteria. The current characteristics of Mycobacterium avium complex pulmonary disease (MAC-PD) were compared with those in the 1980s and circa 2000.

Results

We identified a total of 3,546 pulmonary TB cases and 2,155 NTM-PD cases. While the annual number of incident pulmonary TB cases remained stable over the study period (P = 0.59), that of NTM-PD cases increased significantly from 165 to 278 (P < 0.01). The mean age of pulmonary TB cases increased from 59.7 ± 16.3 to 66.2 ± 21.7 years, whereas that of NTM-PD cases remained unchanged. Regarding the age distribution, the greatest increases were observed in patients over 75 years for TB and in patients 50–74 years for NTM. The most common causative organism for NTM was Mycobacterium avium complex (87.3%), M. abscessus complex (5.5%) and M. kansasii (3.9%). Among patients with MAC-PD, the proportion of the nodular bronchiectatic (NB) form increased significantly from 60.0% to 84.4% between circa 2000 and 2016 (P < 0.01). Significant increases in the NB form were observed in both males (33.3%–70.7%, P < 0.01) and females (71.3%–89.2%, P < 0.01).

Conclusions

The annual number of incident NTM-PD cases increased markedly. In contrast to patients with TB, the mean age of new NTM-PD patients did not increase in the last 10 years. Among MAC-PD patients, the proportions accounted for by the NB form increased significantly in both sexes.

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Highlights

•	The increase in NTM-PD cases was mainly due to increased MAC-PD cases in Japan.
•	Age of new NTM-PD patients did not increase in the last 10 years in contrast to TB.
•	Significant increases in the NB form among MAC-PD cases were observed in both sexes.
•	The incident number of MABC-PD cases has recently increased.

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Keywords : Nontuberculous mycobacteria, Tuberculosis, Clinical features, Epidemiology, Japan