• Tuberculosis and Respiratory Diseases
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• 제80권2호
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• pp.153-158
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• 2017

Background: Recently, increased levels of high-mobility group box 1 protein (HMGB1) have been identified in various inflammatory conditions and infections. However, no studies have evaluated the HMGB1 level in nontuberculous mycobacterial (NTM) lung disease, and compared it to mycobacterial lung disease. Methods: A total of 60 patients newly diagnosed with NTM lung disease, 44 culture-positive pulmonary tuberculosis (TB) patients, and 34 healthy controls, were included in this study. The serum HMGB1 concentrations were quantified using HMGB1 enzyme-linked immunosorbent assay kits. Results: Serum HMGB1 level in patients with pulmonary TB or NTM lung disease, was significantly lower than that of the healthy controls. In addition, the serum HMGB1 level in TB patients was significantly lower than patients with NTM lung disease. However, the levels in NTM patient subgroups did not differ according to the causative species, disease progression, and disease phenotype. Conclusion: Although low levels of serum HMGB1 has the potential to be a marker of mycobacterial lung disease, these levels were unable to differentiate disease progression and disease phenotype in NTM lung diseases.

• Tuberculosis and Respiratory Diseases
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• 제77권1호
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• pp.1-5
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• 2014

The recovery of nontuberculous mycobacteria (NTM) from respiratory specimens and the number of patients with NTM lung disease have been rapidly increasing in Korea. An early differential diagnosis of NTM lung disease from pulmonary tuberculosis (TB) is important, as the therapeutic regimen differs from that of pulmonary TB, and it is not necessary to track the contacts of patients with NTM lung disease. However, differentiating NTM lung disease from pulmonary TB remains difficult, because the clinical presentations of the two diseases are similar and a definite diagnosis of NTM lung disease based on sputum culture takes time. This review focuses on the changing epidemiology, clinical and radiographic manifestation, and laboratory diagnosis of pulmonary TB and NTM lung disease in Korea.

• 대한영상의학회지
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• 제82권4호
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• pp.838-850
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• 2021

비결핵마이코박테륨(nontuberculous mycobacterium; 이하 NTM) 폐질환은 우리나라를 포함하여 전 세계적으로 발생률과 유병률이 증가하고 있다. 더불어 NTM 폐질환의 임상적 중요성도 빠르게 증가하고 있으나, NTM 폐질환은 진단과 치료가 어려운 질환이다. NTM 폐질환의 진단을 위해서는 영상의학적 근거가 필수이며, 많은 환자에서 영상의학 소견은 NTM 폐질환을 진단하는 첫 번째 근거가 될 수 있다. NTM 폐질환의 영상의학 소견은 일반적으로 섬유공동병변형과 결절기관지확장형의 두 가지 형태로 구분하나, NTM 폐질환은 다양하고 비특이적인 영상의학 소견을 보일 수 있다. 영상의학과 의사는 영상의학 소견에 따라 NTM 폐질환의 가능성을 감별진단에 포함하여야 한다. 본 종설은 영상의학과 의사를 위한 NTM 폐질환의 국내 역학, 진단기준, 영상의학 소견을 중심으로 검토하였다.

• Tuberculosis and Respiratory Diseases
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• 제79권2호
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• pp.74-84
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• 2016

Nontuberculous mycobacteria (NTM) are emerging pathogens that affect both immunocompromised and immunocompetent patients. The incidence and prevalence of NTM lung disease are increasing worldwide and rapidly becoming a major public health problem. For the diagnosis of NTM lung disease, patients suspected to have NTM lung disease are required to meet all clinical and microbiologic criteria. The development of molecular methods allows the characterization of new species and NTM identification at a subspecies level. Even after the identification of NTM species from respiratory specimens, clinicians should consider the clinical significance of such findings. Besides the limited options, treatment is lengthy and varies by species, and therefore a challenge. Treatment may be complicated by potential toxicity with discouraging outcomes. The decision to start treatment for NTM lung disease is not easy and requires careful individualized analysis of risks and benefits. Clinicians should be alert to those unique aspects of NTM lung disease concerning diagnosis with advanced molecular methods and treatment with limited options. Current recommendations and recent advances for diagnosis and treatment of NTM lung disease are summarized in this article.

• Tuberculosis and Respiratory Diseases
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• 제77권4호
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• pp.161-166
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• 2014

Since tuberculosis (TB) remains a major global health concern and the incidence of multi-drug resistant (MDR)-TB is increasing globally, new modalities for the detection of TB and drug resistant TB are needed to improve TB control. The Xpert MTB/RIF test can be a valuable new tool for early detection of TB and rifampicin resistance, with a high sensitivity and specificity. Late-generation fluoroquinolones, levofloxacin, and moxifloxacin, which are the principal drugs for the treatment of MDR-TB, show equally high efficacy and safety. Systemic steroids may reduce the overall TB mortality attributable to all forms of TB across all organ systems, although inhaled corticosteroids can increase the risk of TB development. Although fixed dose combinations were expected to reduce the risk of drug resistance and increase drug compliance, a recent meta-analysis found that they might actually increase the risk of relapse and treatment failure. Regarding treatment duration, patients with cavitation and culture positivity at 2 months of TB treatment may require more than 6 months of standard treatment. New anti-TB drugs, such as linezolid, bedaquiline, and delamanid, could improve the outcomes in drug-resistant TB. Nontuberculous mycobacterial lung disease has typical clinical and immunological phenotypes. Mycobacterial genotyping may predict disease progression, and whole genome sequencing may reveal the transmission of Mycobacterium abscessus. In refractory Mycobacterium avium complex lung disease, a moxifloxacin-containing regimen was expected to improve the treatment outcome.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.15-26
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• 2019

The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.

• Tuberculosis and Respiratory Diseases
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• 제47권6호
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• pp.735-746
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• 1999

연구배경: 폐 비결핵항산균증은 최근 빈도가 급증하고 있으며 이에 따라 그 진단과 치료에 있어서 많은 변화와 발전이 이루어지고 있다. 최근의 증례 증가에도 불구하고 이에 대한 국내 임상연구는 매우 드문 실정이어서 본 연구를 시행하였다. 방 법: 1990년 1월부터 1998년 8월까지 서울대병원에서 검사한 호흡기검체에서 비결핵항산균이 배양되었던 57예 중 1997년 개정된 미국 흉부학회 진단기준에 적합한 27예를 대상으로 임상상, 방사선소견, 치료 및 임상경과를 후향적으로 분석하였다. 결 과: 남자 15명, 여자 12명이였고 평균연령은 51.5세였다. 20명(74.1%)에서 선행 폐질환이 있었고 이 중 19명(70.4%)은 폐결핵의 기왕력이 있었다. 방사선 소견상 16명(59.2%)에서 공동이 있었고, 추적관찰시 대부분에서 1년이상에 걸쳐 서서히 변화하는 양상을 보였다. 항결핵제에 대한 감수성검사상 INH 100%, RMP 72.2%, EMB 81.5%, PZA 92.6%의 내성율을 보였고, 2차 항결핵제에 대해서도 평균 66.1%의 높은 내성율을 보였다. 약물치료는 21명(77.8%)에서 시행되었고 11명은 호전, 10명은 악화되었다. 치료하지 않은 6명(22.2%)은 1명만이 호전, 5명은 악화되었다. 임상경과에 영향을 미치는 요인을 분석하였을 때 공동이 있거나 사용된 감수성 약제수가 3제미만인 경우 치료반응이 유의하게 나빴다. 결 론: 우리나라의 폐 비결핵항산균증은 최근 증가하고 있으며 선행 폐질환이 있는 중년이상의 환자에서 많이 발생하고 선행 폐질환으로는 과거의 결핵병변이 압도적으로 많다. 기존의 항결핵제로는 치료성적이 좋지 않으므로 새로운 약제를 중심으로 하는 감수성검사와 이에 따른 치료약제의 변화가 시급히 필요하리라 생각된다. 또한, 앞으로 많은 수의 환자를 대상으로 하는 임상연구를 통하여 우리나라자체의 진단과 치료지침이 세워져야 할 것이다.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.416-418
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• 2015

Mycobacterium shinjukuense is a novel species of nontuberculous mycobacteria (NTM) that was first reported in Japan in 2011. It is a slow-growing NTM pathogen that can cause chronic pulmonary infections. There are only a few reported cases of M. shinjukuense infections, all of which are from Japan. We reported a case of chronic lung disease caused by M. shinjukuense. The organism was identified by 16S rRNA, rpoB, and hsp65 gene sequencing. To the best of our knowledge, this was the first confirmed case of lung disease caused by M. shinjukuense outside of Japan.

• Tuberculosis and Respiratory Diseases
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• 제74권4호
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• pp.187-190
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• 2013

We report a rare case of lung disease caused by Mycobacterium lentiflavum in a previously healthy woman. A 54-year-old woman was referred to our hospital due to chronic cough and sputum. A computed tomography scan of the chest revealed bilateral bronchiectasis with bronchiolitis in the right middle lobe and the lingular division of the left upper lobe. Nontuberculous mycobacteria were isolated twice from three expectorated sputum specimens. All isolates were identified as M. lentiflavum by multilocus sequence analysis based on rpoB, hsp65, and 16S rRNA fragments. To the best of our knowledge, this is the first documented case of M. lentiflavum lung disease in an immunocompetent adult in Korea.

• Tuberculosis and Respiratory Diseases
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• 제76권1호
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• pp.30-33
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• 2014

We report the first Korean case of lung diseases caused by Mycobacterium abscessus subsp. bolletii in a previously healthy male, except for a previous history of pulmonary tuberculosis and bronchiectasis. All serial isolates are identified as M. abscessus subsp. bolletii by multi-locus sequence analysis based on the hsp65, rpoB, and 16S rRNA fragments. At the genetic level, the isolate has the erm(41) gene with a T28 sequevar, associated with clarithromycin resistance, and no rrl mutation. The isolate is resistant to clarithromycin. Although the symptoms and radiographic findings have improved after combination of antibiotics, the follow-up sputum cultures are persistently positive.