Author : Phung Kim Lam
Publisher :
ISBN 13 :
Total Pages : 270 pages
Book Rating : 4.:/5 (318 download)
Book Synopsis Factors Associated with Mycobacterium Avium Complex Infection and Pulmonary Disease Progression by : Phung Kim Lam
Download or read book Factors Associated with Mycobacterium Avium Complex Infection and Pulmonary Disease Progression written by Phung Kim Lam and published by . This book was released on 2005 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt: Mycobacterium avium complex (MAC), a resilient and ubiquitous non-tuberculous mycobacterium (NTM) commonly found in water and soil, is a pathogen that can cause infection or pulmonary disease (MAC-PD). MAC-PD is an emerging condition but remains under-studied, particularly in characterizing infection, disease progression, and risk factors. Initially, a case-control study of San Diego patients examined factors associated with being culture-positive for MAC (n=62), relative to being positive for rapid-grower (n=32) and culture-negative (n=44). The majority of MAC+ patients had underlying lung diseases (82% with abnormal radiographs) but only one-third was suspected of having MAC disease (32% underwent treatment). Compared to the culture-negative group, the MAC+ group was 3.4 (95% CI: 1.2-9.7) times more likely to be born in coastal states. Compared to the more healthy rapid-growers group, the MAC+ group had significantly higher bacilli load (23% vs. 16% smear-positive), lower average body mass index (BMI, 22 vs. 28 kg/m2), and lower average serum albumin concentration (30 vs. 33 g/l). Subsequently, survival analysis of a national study focused on factors associated with MAC-PD improvement in 95 HIV-negative older adults. Originally enrolled in a trial of interferon-gamma treatment, all subjects received standard mycobacterial drug therapy three-times-weekly (TIW), instead of daily, for one year. TIW response was low (e.g., 44% had culture improvement). Patients with non-cavitary disease had 4.0 (95% CI: 1.7-9.2) times greater culture and 4.9 (95% CI: 1.9-13.0) times greater CT response rates than those with cavitary disease. Older, smear-negative, or previously untreated subjects, and those with longer ethambutol use or without severe pulmonary presentations also had greater improvement. In unadjusted analyses, culture improvement was significantly associated with use of multivitamin (HR=2.4), vitamin E (HR=3.2), and calcium supplements (HR=4.2), BMI e"9 kg/m2 (HR=2.2), and serum albumin e"6 g/l (HR=2.4); albumin e"4 g/l was also associated with CT improvement (HR=4.5). However, after adjusting for cavitary disease and other indicators of disease severity, these associations diminished significantly. Only use of calcium supplements remained independently associated with culture improvement (HR=4.0; 95% CI=1.6-9.7), but cause and effect cannot be assumed. Further research is needed to validate these findings, particularly under long-term treatment
