CLINICAL-FEATURES OF PULMONARY-DISEASE CAUSED BY RAPIDLY GROWING MYCOBACTERIA - AN ANALYSIS OF 154 PATIENTS

The role of rapidly growing mycobacteria (RGM) as pulmonary pathogens has been unclear. We identified 154 cases of lung disease caused by RG M using the microbiologic and radiographic criteria of the American Th oracic Society (ATS) and availability of the causative organism for st udy. More than one third of patients had positive lung biopsy cultures . Patients were predominately white (83%), female (65%) nonsmokers (66 %), and they had prolonged periods from onset of symptoms to diagnosis of their disease. Cough was an almost universal presenting symptom, w hereas constitutional symptoms became more important with progression of disease. Upper lobe infiltrates were most common (88%), with 77% of patients developing bilateral disease. Cavitation was present in only 16% of the patients. Specific underlying diseases were infrequent, bu t they included previously treated mycobacterial disease (18%), coexis tent Mycobacterium avium complex (8%), cystic fibrosis (6%), and gastr oesophageal disorders with chronic vomiting (6%). The majority of isol ates (82%) were M. abscessus (formerly M. chelonae subsp. abscessus). Effective treatment for M. fortuitum lung disease was accomplished wit h drug therapy, whereas surgical resection of localized disease was th e only effective long-term therapy for M. abscessus. Although the dise ase was generally slowly progressive, 21 of 154 (14%) patients died as a consequence of progressive RGM lung disease and respiratory failure . RGM should be recognized as a cause of chronic mycobacterial lung di sease, and respiratory isolates should be assessed carefully.