A case of non-cystic fibrosis bronchiectasis associated with nontuberculous mycobacteria and Pseudomonas aeruginosa infection diagnosed by metagenome sequencing: Non-cystic fibrosis bronchiectasis associated with nontuberculous mycobacteria

Mengmeng Zhao; Qiuliang Ji; Surendra Shrestha; Yuan Zhang; Jingyun Shi

doi:10.54844/cai.2022.0162

Authors

Mengmeng Zhao Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
Qiuliang Ji Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
Surendra Shrestha Om Aasha Hospital Pvt. Ltd, Dhangadhi 10900, Nepal
Yuan Zhang Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
Jingyun Shi Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China

DOI:

https://doi.org/10.54844/cai.2022.0162

Keywords:

infection, non-tuberculosis mycobacterium

Abstract

This report describes a 68-year-old woman with non-cystic fibrosis bronchiectasis (“bronchiectasis”) associated with nontuberculous mycobacteria (NTM) infection. She presented with cough, expectoration, bronchiectasis, and a negative QuantiFERON tuberculosis (QFT) test. But her sputum and bronchoalveolar lavage fluid (BALF) tested acid-fast bacilli (AFB) positive. The patient had a nine-year history of autoimmune liver disease and was diagnosed with liver cirrhosis for 1 year. Metagenomics next generation sequencing (mNGS) of her BALF sample reported positive for NTM and Pseudomonas aeruginosa (PA). According to the patient's clinical features and consultations with respiratory and tuberculosis specialists, the patient was not prescribed anti-tuberculosis treatment. Rather, her symptoms improved with anti-PA treatment. This case report also emphasizes the importance of avoiding anti-tuberculosis treatment immediately after an initial diagnosis of non-tuberculous mycobacterial pneumonia.report also emphasizes the importance of avoiding anti-tuberculosis treatment immediately after an initial diagnosis of non-tuberculous mycobacterial pneumonia.

References

Cowman S, van Ingen J, Griffith DE, Loebinger MR. Nontuberculous mycobacterial pulmonary disease. Eur Respir J 2019;54:1900250.

Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ Jr, Andrejak C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J 2020;56:2000535.

Marras TK, Mendelson D, Marchand-Austin A, May K, Jamieson FB. Pulmonary nontuberculous mycobacterial disease, Ontario, Canada, 1998-2010. Emerg Infect Dis 2013;19:1889–1891.

Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med 2012;185:881–886.

Morimoto K, Iwai K, Uchimura K, Okumura M, Yoshiyama T, Yoshimori K, et al. A steady increase in nontuberculous mycobacteriosis mortality and estimated prevalence in Japan. Ann Am Thorac Soc 2014;11:1–8.

Zhu YN, Xie JQ, He XW, Peng B, Wang CC, Zhang GJ, et al. Prevalence and clinical characteristics of nontuberculous mycobacteria in patients with bronchiectasis: a systematic review and meta-analysis. Respiration 2021;100:1218–1229.

Ringshausen FC, Wagner D, de Roux A, Diel R, Hohmann D, Hickstein L, et al. Prevalence of nontuberculous mycobacterial pulmonary disease, Germany, 2009-2014. Emerg Infect Dis 2016;22:1102–1105.

Chen X, Zhang Y, Xu J, Li H. Establishment and validation of a predictive model for nontuberculous mycobacterial infections in acid-fast bacilli smear-positive patients. Clin Respir J 2021;15:1147–1157.

Hwang JA, Kim S, Jo KW, Shim TS. Natural history of Mycobacterium avium complex lung disease in untreated patients with stable course. Eur Respir J 2017;49:1600537.

Lee G, Lee KS, Moon JW, Koh WJ, Jeong BH, Jeong YJ, et al. Nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Natural course on serial computed tomographic scans. Ann Am Thorac Soc 2013;10:299–306.

Koh WJ, Moon SM, Kim SY, Woo MA, Kim S, Jhun BW, et al. Outcomes of Mycobacterium avium complex lung disease based on clinical phenotype. Eur Respir J 2017;50:1602503.