The summary page of the 1997 ATS statement suggests that infiltrate without nodules or caviy may be a marker of NTM pulmonary disease. Many physicians refer to the summary when diagnosing NTM. More detailed criteria within the document suggest that infiltrates must be present >2 months in order to diagnose disease. We investigated whether untreated patients diagnosed using the summary criteria would have adverse outcomes.
We reviewed the records of the 126 adults in our institution with at least one respiratory culture positive for NTM between January 1998 and June 2002. We identified 44 patients who met the summary criteria for pulmonary NTM disease based on the summary in the 1997 ATS statement.
Of the 44 patients with summary criteria for disease, we identified 19 patients who were not offered treatment. 9 of these patients had infiltrate without other radiographic findings. 5 had nodules alone, 3 had cavities alone, and 2 had multiple findings. 7 of the 9 patients with infiltrate alone did not have persistent infiltrate. All 7 of these patients improved. Of the 2 patients with persistent infiltrate, 1 remained stable and one declined. Table 1Infiltrate Alone (n=9)Nodules Alone (n=5)Cavity Alone (n=3)Multiple Findings (n=2)Improved7101Stable1100Deteriorated1210Died0110Inadequate followup0011shows outcomes by radiographic subgroups.CONCLUSIONS: The 1997 ATS statement suggests criteria to diagnose NTM pulmonary disease, but the body of the paper gives more detailed criteria than the summary. We found that when using the summary criteria, 77% of untreated patients with infiltrate alone showed improvement.
The clinical stability of patients with infiltrate as the sole radiographic finding may imply a less severe disease process that may not require multi-drug therapy. Physicians should also be made aware of the differences between the summary of diagnostic criteria and the more detailed criteria within the body of the statement. However, further studies should investigate whether patients with non-persistent infiltrates are being started on treatment.
H. Jaffery, None.