Sex-Associated Radiographic and Clinical Differences in Nontuberculous Mycobacteria Pulmonary Disease
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Published on: February 26, 2018
Bryan Garcia1, Matthew Mullins2, Lindsay Lim3
1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Background:
The incidence of infections caused by nontuberculous mycobacteria (NTM) are steadily increasing worldwide, and the most common site of infection is the lung. Clinical characteristics of individuals with NTM pulmonary disease (NTM-PD) demonstrate pronounced geographical heterogeneity. In the United States, NTM-PD has an affinity for postmenopausal White females, many of whom are never-smokers, whereas in Asia, NTM-PD is more common in males with post-tuberculosis lung disease. While these geographical differences are known on the global scale, it remains unclear whether radiographic sex-associated differences in NTM-PD are present within the U.S. cohort.
Objective/Method:
In this single center, cross-sectional retrospective study of our patient registry, we sought to assess this knowledge gap by comparing radiographic and clinical features of individuals with NTM-PD by sex.
Results:
We observed a significant preponderance of cavitary disease in men, while women commonly presented with bilateral apical fibrosis, increased nodules and tree-in-bud patterns in the lower lobes, and an increased risk of refractory disease and concomitant co-infection.
Conclusion:
Results from this study demonstrate several sex-associated differences in the radiographic phenotype of NTM-PD and may be the result of differences in pre-existing risk factors that contribute to the development of NTM-PD. Future studies will be required to better assess the broad applicability of these findings to centers from other geographic regions where the underlying etiology of disease may vary.
Insights
Nontuberculous mycobacteria (NTM) lung infections show sex-specific radiographic differences in the U.S. Men often have cavitary disease, while women experience fibrosis, nodules, and higher refractory disease risk.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Radiology
Background:
- Nontuberculous mycobacteria (NTM) infections are increasing globally, primarily affecting the lungs.
- NTM pulmonary disease (NTM-PD) exhibits geographical variations in patient demographics and risk factors.
- U.S. NTM-PD typically affects postmenopausal White females, often never-smokers, contrasting with Asian populations where males with prior tuberculosis are more affected.
Purpose of the Study:
- To investigate potential sex-associated differences in radiographic presentations of NTM pulmonary disease (NTM-PD) within a U.S. patient cohort.
- To compare clinical and radiographic features of NTM-PD between males and females.
- To address the knowledge gap regarding sex-specific NTM-PD phenotypes in the United States.
Main Methods:
- A single-center, cross-sectional retrospective study utilizing patient registry data.
- Comparison of radiographic and clinical characteristics of NTM-PD patients stratified by sex.
- Analysis of imaging findings and disease outcomes based on patient sex.
Main Results:
- Men with NTM-PD showed a significant preponderance of cavitary disease.
- Women presented more frequently with bilateral apical fibrosis, nodules, and tree-in-bud patterns in lower lobes.
- Females had an increased risk of refractory NTM-PD and concomitant co-infections.
Conclusions:
- Significant sex-associated differences exist in the radiographic phenotype of NTM pulmonary disease within the U.S.
- These differences may stem from variations in pre-existing risk factors contributing to NTM-PD development.
- Further research is needed to validate these findings across diverse geographic regions and etiologies.
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