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Nontuberculous mycobacterial infection after lung transplantation
( Youngmok Park ),( Song Yee Kim ),( Moo Suk Park ),( Su Jin Jeong ),( Jin Gu Lee ),( Hyo Chae Paik ),( Young Ae Kang ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: Nontuberculous mycobacteria (NTM) infection is an important issue after lung transplantation, but the incidence and mortality data are insufficient. We present our experience with pulmonary NTM infection after lung transplantation. Methods: We retrospectively evaluated the lung transplant recipients between January 2013 and December 2018. Bronchoscopies were performed according to the surveillance protocol and clinical indications. The diagnosis of pulmonary NTM colonization was defined by a positive NTM culture in a bronchoalveolar lavage specimen or at least two separate sputum samples. NTM pulmonary disease (NTM-PD) was diagnosed according to the American Thoracic Society/Infectious Disease Society of America 2007 guidelines. Log-rank test and Cox regression models were used to assess the relationship between NTM and all-cause mortality. Results: A total of 210 recipients were enrolled. The median age at transplantation was 56 years, and 61% were males. Fourteen (7%) patients were diagnosed with NTM colonization at a median of 11.8 (IQR 1.7-22.2) months after transplantation. Nine (4%) patients were diagnosed with NTM-PD, and the incidence of NTM-PD was 2219/100,000 person-year. Mycobacterium abscessus (56%) was the most common species in NTM-PD, followed by M. avium (22%) and M. intracellulare (22%). NTM colonization group had better survival after transplantation (Log-rank P = 0.02) and showed decreased the risk of all-cause mortality (HR 0.22, 95% CI 0.06-0.91, P=0.037). NTM-PD group showed no difference in mortality. Conclusions: The incidence of NTM-PD is considerable in lung transplantation recipients. NTM colonized patients had better survival outcomes than the control group after lung transplantation.
Environmental risk factors for the development of nontuberculous mycobacterial pulmonary disease
( Youngmok Park ),( Moo Suk Park ),( Young Sam Kim ),( Joon Chang ),( Young Ae Kang ) 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-
Background: Nontuberculous mycobacterium (NTM) is a ubiquitous pathogen found in soil and water. Environmental exposure is the primary route for NTM pulmonary disease (NTM-PD). In this study, we evaluated the environmental risk factors in immunocompetent patients with NTM-PD. Methods: A case-control study was performed with 75 patients with NTM-PD (males, 16 [21.3%]; age, 65 [IQR 60-70] years) and 23 control patients with other pulmonary diseases (males, 14 [60.9%]; age, 66 [IQR 61-70] years). All subjects completed a standardized questionnaire about medical history, smoking history, and environmental exposures, including soil exposure from farming or gardening; water exposure from showering, hot tub use, public bath use, dishwashing, swimming, or drinking water; and pet exposure. Results: Patients with NTM-PD had lower BMI (21.0 vs. 22.9 kg/m2, P=0.008) than the control group. Sixty-one patients had more water exposure from dishwashing (≥1 per day) than the control patients (81.3% vs. 52.2%, P=0.011). However, there was no difference in soil exposure including farming and gardening, and other water exposure including showering, public bath use, or hot tub use. Underlying diseases and pet exposure also did not differ between the two groups. Conclusions: Patients with NTM-PD had more water exposure from dishwashing than control patients. However, we should interpret the results with caution due to the gender difference in case and control groups.
( Youngmok Park ),( Ji Ye Jung ),( Young Sam Kim ),( Ju Hye Shin ),( Yeon Mok Oh ),( Sang Min Lee ),( Joon Beom Seo ),( Sang Do Lee ) 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.0
The plasma vitamin D level is generally low in COPD, and vitamin D binding protein (GC) polymorphisms are related to the development of COPD. We investigated relationship between GC polymorphisms and vitamin D level, and their effects on clinical outcomes in Korean patients with COPD. A total of 175 patients with COPD from KOLD Cohort were analyzed. Multivariate analysis was conducted by adjusting age, BMI, lung function, smoking status, smoking amount, and seasonal variation of vitamin D level. Vitamin D deficiency was defined as plasma 25-OH-Vit D3 level of less than 20 ng/mL. GC1F (44.3%) and 1F-2 (27.4%) were the most common variant and genotype. Mean plasma vitamin D level was 17.5 ng/mL with seasonal variation. Plasma vitamin D level was lower in patients with GC2 variant and higher in those with genotype 1F-1S. GC2 variant was a significant risk factor for vitamin D deficiency (OR=2.41). In relation to various clinical outcomes in COPD patients, vitamin D deficiency was associated with lower FEV11/FVC regardless of GC polymorphism. FEV₁/FVC was higher in genotype 1F-1F group and lower in genotype 1F-2 group. 6MW distance was shorter in variant GC1F group and longer in variant GC2 group. Emphysema index was higher in variant GC1S group or genotype 1F-1S group, and lower in genotype 1S-1S group, while it was not related with vitamin D level. In conclusion, GC2 variant was a risk factor and genotype 1F-1S was a protective factor for vitamin D deficiency. GC polymorphisms and vitamin D deficiency were related with clinical outcomes of Korean patients with COPD.