Bronchoscopy has proven highly effective in diagnosing nontuberculous mycobacterial pulmonary disease (NTM-PD), a challenging infection that is on the rise, particularly in the elderly.
Even when the infection could not be detected in sputum, bronchoscopy successfully identified mycobacteria in about half the patients suspected of having NTM-PD. That’s according to a study by Dr. Yutaka Tomishima and others done in Tokyo, Japan, and published in Respiratory Investigation.
The retrospective cohort study included 2,657 patients who underwent bronchoscopy and mycobacterial culture between January 2004 and June 2018.
A total of 919 patients were diagnosed with lung cancer, 19 patients showed positive culture for nontuberculous mycobacteria (NTM) and 14 patients showed findings for NTM-PD, according to the research. NTM-PD was suspected before bronchoscopy in 199 patients.
It’s unclear why there was an increase in cases of the infection, according to researchers.
Separate research out of Korea found that patients diagnosed with NTM-PD using bronchoscopic or lung tissue specimens showed lower risk of disease progression than those diagnosed based on sputum culture.
That study said that the prevalence and mortality of the disease has steadily increased worldwide since 2000.
Although underlying lung disease is a well-established risk factor for NTM-PD, it also occurs in seemingly healthy individuals, according to Dr. S. Cowman and others in a review entitled, “Non-Tuberculous Mycobacterial Pulmonary Disease,” published in European Respiratory Journal.
No common genetic or immunological defect has been identified, the authors say.
“It is likely that multiple pathways contribute towards host susceptibility to NTM-PD which further interact with environmental and microbiological factors leading to the development of disease,” the authors write.
Some patients remain stable without the need for treatment, while others develop refractory disease, which can lead to significant illness and can be fatal.
A rising number of cases of the disease are being identified in the U.K., according to Dr. Marc Lipman and others in their writing, “Current and Future Management of Non-Tuberculous Mycobacterial Pulmonary Disease (NTM-PD) in the UK.”
Although they acknowledged there are many uncertainties around the disease, they say identified risk factors of NTM-PD include:
A lack of standardized diagnostic testing for the infection causes delays in diagnosis, Lipman and his co-authors write. They suggest the creation of a position for NTM specialist nurses given the complexities and chronic nature of care and the rising caseload.