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Original Research: CHEST INFECTIONS |

Lung Manifestations in an Autopsy-Based Series of Pulmonary or Disseminated Nontuberculous Mycobacterial DiseaseNontuberculous Mycobacterial Disease Autopsies

Meghan L. O’Connell, BA; Kate E. Birkenkamp, MPH; David E. Kleiner, MD; Les R. Folio, DO, MPH; Steven M. Holland, MD; Kenneth N. Olivier, MD, MPH
Author and Funding Information

Laboratory of Clinical Infectious Diseases (Mss O’Connell and Birkenkamp and Drs Holland and Olivier), National Institute of Allergy and Infectious Diseases; Laboratory of Pathology (Dr Kleiner), National Cancer Institute; and Department of Radiology and Imaging Sciences (Dr Folio), Clinical Center, National Institutes of Health, Bethesda, MD.

Correspondence to: Kenneth N. Olivier, MD, MPH, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg 10, Room 11N234, Bethesda, MD 20892-1888; e-mail: olivierk@niaid.nih.gov


Ms Birkenkamp is currently at the University of Minnesota Medical School (Minneapolis, MN).

Mss O’Connell and Birkenkamp contributed equally to this study.

Funding/Support: This research was supported by the Intramural Research Programs of the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, and the National Institutes of Health Clinical Center.

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


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1203-1209. doi:10.1378/chest.11-0425
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Background:  Comparisons of lung manifestations in primary pulmonary vs disseminated nontuberculous mycobacterial disease have not been well described. The clinical, histopathologic, and radiologic disease manifestations of primary pulmonary or disseminated nontuberculous mycobacterial disease were compared in an autopsy series.

Methods:  Medical and microbiologic records, autopsy reports, histopathologic slides of the lungs, and chest CT scans were reviewed on patients at the National Institutes of Health with nontuberculous mycobacterial disease who died between 1996 and 2010.

Results:  The 11 patients with primary pulmonary nontuberculous mycobacterial disease were predominantly female (n = 9), with symptom onset at median 50 (range 35, 71) years and time from onset until death of 12 (3, 34) years. Bronchiectasis with cavity formation and necrotizing bronchocentric granulomatous inflammation predominated but extrapulmonary infection was absent. The five patients with disseminated disease and systemic immune defects were all men with age at onset of 2 (0.33, 33) years and time from onset of disease until death of 9 (1, 31) years. Miliary nodules and/or consolidation with poorly formed granulomatous inflammation were noted in the three disseminated patients with mycobacterial lung involvement. Significant extrapulmonary infection was noted in all five with a relative paucity of lung findings.

Conclusions:  Nontuberculous mycobacteria can cause progressive, fatal disease. Primary pulmonary disease is bronchocentric and lacks extrathoracic infection consistent with impaired airway surface defenses. In contrast, fatal disseminated infections involving the lung have hematogenous spread, extensive extrathoracic disease, and a distinct pulmonary histopathology consistent with systemic immune dysfunction.

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