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Correspondence |

Serodiagnosis of Pulmonary Disease Due to Mycobacterium avium Complex Proven by Bronchial Wash Culture FREE TO VIEW

Seigo Kitada, MD; Kazuo Kobayashi, MD; Yukiko Nishiuchi, MD; Kenji Fushitani, MD; Kenji Yoshimura, MD; Yoshitaka Tateishi, MD; Keisuke Miki, MD; Mari Miki, MD; Hisako Hashimoto, MD; Masaharu Motone, MD; Takeya Fujikawa, MD; Toru Hiraga, MD; Ryoji Maekura, MD
Author and Funding Information

From the Department of Internal Medicine (Drs Kitada, Fushitani, Yoshimura, Tateishi, K. Miki, M. Miki, Hashimoto, Motone, Fujikawa, Hiraga, and Maekura), National Hospital Organization National Toneyama Hospital; the Department of Immunology (Dr Kobayashi), National Institute of Infectious Diseases; and the Toneyama Institute for Tuberculosis Research (Dr Nishiuchi), Osaka City University Medical School.

Correspondence to: Seigo Kitada, MD, Department of Internal Medicine, National Hospital Organization National Toneyama Hospital, 5-1-1 Toneyama, Toyonaka-shi, Osaka 560-8552; e-mail: kitadase@toneyama.go.jp


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: This research was funded by the Ministry of Health, Labour and Welfare (Research on Emerging and Re-emerging Infectious Diseases and Research on Regulatory Science of Pharmaceuticals and Medical Devices) and the Osaka Tuberculosis Foundation. The enzyme immunoassay kits were gifts from TAUNS Laboratory Inc, Shizuoka, Japan.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):236-237. doi:10.1378/chest.10-0248
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To the Editor:

The diagnosis of Mycobacterium avium complex (MAC) pulmonary disease (MAC-PD) is often complicated and time consuming. MAC-PD is diagnosed according to the guidelines set forth by the American Thoracic Society in 2007, which include clinical and microbiologic criteria.1 Bronchoscopy to obtain bronchial wash for a bacterial culture is often considered in patients in whom MAC-PD is difficult to diagnose by routine sputum examination; however, it is difficult to perform bronchoscopy in all patients. A novel approach to help diagnose such cases has been needed.

We previously reported the usefulness of a serodiagnostic test to determine serum IgA antibodies against a mycobacterial glycopeptidolipid (GPL) core for diagnosing MAC-PD proven by sputum culture.2-5 The present study was conducted to assess the accuracy of this test by comparing the results with bronchial wash cultures in patients with MAC-PD and negative sputum culture.

Bronchoscopy was performed in 56 patients suspected to have MAC-PD based on their symptoms and the presence of small nodular infiltrates with bronchiectasis on chest CT scans. None of the patients were known to be seropositive for HIV. The results of the bronchial wash cultures were positive for MAC in 28 patients (50%), who then received a diagnosis of MAC-PD. The culture results were negative for MAC in the remaining one-half, who were assigned to the non-MAC disease group. The levels of serum IgA antibody against the GPL core antigen of MAC were measured using an enzyme immunoassay kit (TAUNS Laboratory Inc; Shizuoka, Japan) before bronchoscopy, and the values were compared between the two groups.

Serum IgA antibody levels to GPL core antigen were significantly higher in the MAC-PD group (5.0 ± 4.7 U/mL) than in the non-MAC disease group (0.1 ± 0.3 U/mL) (P < .0001). With the cutoff value set at 0.7 U/mL according to a previous study,5 the number of patients with seropositivity and seronegativity with or without MAC-PD is summarized in Table 1. The sensitivity, specificity, and positive and negative predictive values for diagnosing MAC-PD were 78.6%, 96.4%, 95.7%, and 81.8%, respectively.

Table Graphic Jump Location
Table 1 —Results of the Serodiagnostic Test for Mycobacterium avium Complex Pulmonary Disease

The levels of serum IgA antibody to GPL core antigen were significantly higher in the MAC-PD group than in the non-MAC disease group (P < .0001). The sensitivity and specificity for diagnosing MAC-PD were 78.6% and 96.4%, respectively. GPL = glycopeptidolipid; MAC = Mycobacterium avium complex; MAC-PD = M avium complex pulmonary disease.

In conclusion, the serodiagnostic test can accurately predict MAC positivity when compared with the results of bronchial wash cultures and may be safe and useful as an adjunct to diagnose MAC-PD. In particular, we consider that this approach may be useful in elderly patients for whom bronchoscopy cannot be performed because of other underlying conditions or in patients who are reluctant to undergo such an invasive procedure for very mild signs and symptoms.

Griffith DE, Aksamit T, Brown-Elliott BA, et al; ATS Mycobacterial Diseases Subcommittee ATS Mycobacterial Diseases Subcommittee American Thoracic Society Infectious Disease Society of America An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;1754:367-416. [CrossRef] [PubMed]
 
Kitada S, Maekura R, Toyoshima N, et al. Serodiagnosis of pulmonary disease due toMycobacterium aviumcomplex with an enzyme immunoassay that uses a mixture of glycopeptidolipid antigens. Clin Infect Dis. 2002;3511:1328-1335. [CrossRef] [PubMed]
 
Kitada S, Maekura R, Toyoshima N, et al. Use of glycopeptidolipid core antigen for serodiagnosis ofMycobacterium aviumcomplex pulmonary disease in immunocompetent patients. Clin Diagn Lab Immunol. 2005;121:44-51. [PubMed]
 
Kitada S, Nishiuchi Y, Hiraga T, et al. Serological test and chest computed tomography findings in patients withMycobacterium aviumcomplex lung disease. Eur Respir J. 2007;296:1217-1223. [CrossRef] [PubMed]
 
Kitada S, Kobayashi K, Ichiyama S, et al; MAC Serodiagnosis Study Group MAC Serodiagnosis Study Group Serodiagnosis ofMycobacterium avium-complex pulmonary disease using an enzyme immunoassay kit. Am J Respir Crit Care Med. 2008;1777:793-797. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Results of the Serodiagnostic Test for Mycobacterium avium Complex Pulmonary Disease

The levels of serum IgA antibody to GPL core antigen were significantly higher in the MAC-PD group than in the non-MAC disease group (P < .0001). The sensitivity and specificity for diagnosing MAC-PD were 78.6% and 96.4%, respectively. GPL = glycopeptidolipid; MAC = Mycobacterium avium complex; MAC-PD = M avium complex pulmonary disease.

References

Griffith DE, Aksamit T, Brown-Elliott BA, et al; ATS Mycobacterial Diseases Subcommittee ATS Mycobacterial Diseases Subcommittee American Thoracic Society Infectious Disease Society of America An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;1754:367-416. [CrossRef] [PubMed]
 
Kitada S, Maekura R, Toyoshima N, et al. Serodiagnosis of pulmonary disease due toMycobacterium aviumcomplex with an enzyme immunoassay that uses a mixture of glycopeptidolipid antigens. Clin Infect Dis. 2002;3511:1328-1335. [CrossRef] [PubMed]
 
Kitada S, Maekura R, Toyoshima N, et al. Use of glycopeptidolipid core antigen for serodiagnosis ofMycobacterium aviumcomplex pulmonary disease in immunocompetent patients. Clin Diagn Lab Immunol. 2005;121:44-51. [PubMed]
 
Kitada S, Nishiuchi Y, Hiraga T, et al. Serological test and chest computed tomography findings in patients withMycobacterium aviumcomplex lung disease. Eur Respir J. 2007;296:1217-1223. [CrossRef] [PubMed]
 
Kitada S, Kobayashi K, Ichiyama S, et al; MAC Serodiagnosis Study Group MAC Serodiagnosis Study Group Serodiagnosis ofMycobacterium avium-complex pulmonary disease using an enzyme immunoassay kit. Am J Respir Crit Care Med. 2008;1777:793-797. [CrossRef] [PubMed]
 
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