Related Experiment Videos
Isolation of mycobacteria in patients with pulmonary alveolar proteinosis
L A Witty1, V F Tapson, C A Piantadosi
1Division of Allergy, Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Abstract:
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by accumulation of proteinaceous material in the alveoli of affected individuals. Pulmonary infections appear to develop with increased frequency in these patients. The increased rate of infection has been attributed to immunologic aberrations, such as impaired alveolar macrophage function, particularly when uncommon pathogens are involved. Among those pathogens, Nocardia asteroides and Mycobacterium tuberculosis have appeared most often in case reports in the literature. Mycobacterium avium-intracellulare (MAI) has rarely been isolated in these patients. We report an unusually high incidence of MAI isolation from lavage fluid in 8 of 19 consecutive patients who underwent therapeutic lung lavage for relief of symptomatic PAP, and summarize the available literature on isolation of potential respiratory pathogens in PAP.
Insights
Pulmonary alveolar proteinosis (PAP) patients frequently develop infections. This study found an unusually high incidence of Mycobacterium avium-intracellulare (MAI) infections in PAP patients undergoing lung lavage.
Area of Science:
- Pulmonology
- Infectious Diseases
- Immunology
Background:
- Pulmonary alveolar proteinosis (PAP) is a rare lung disorder with protein accumulation in alveoli.
- Patients with PAP have an increased risk of pulmonary infections, often due to impaired alveolar macrophage function.
- Common pathogens include Nocardia asteroides and Mycobacterium tuberculosis, while Mycobacterium avium-intracellulare (MAI) is rarely reported.
Purpose of the Study:
- To report a high incidence of MAI isolation in PAP patients undergoing therapeutic lung lavage.
- To review and summarize the literature on respiratory pathogens isolated in PAP patients.
Main Methods:
- Retrospective analysis of lavage fluid from 19 consecutive PAP patients undergoing therapeutic lung lavage.
- Literature review of respiratory pathogens identified in PAP patients.
Main Results:
- MAI was isolated from 8 of 19 (42%) consecutive PAP patients.
- This incidence of MAI is significantly higher than previously reported in the literature for PAP patients.
- Literature review confirms a broad range of potential respiratory pathogens in PAP, but MAI is uncommon.
Conclusions:
- There is a high, previously unrecognized incidence of MAI isolation in PAP patients undergoing therapeutic lung lavage.
- Impaired immune function in PAP may predispose patients to infections with less common pathogens like MAI.
- Further investigation into the specific immunological defects and optimal management strategies for MAI in PAP is warranted.