Surgical Outcome of Mycobacterium other than Mycobacterium Tuberculosis Pulmonary Disease

Between January 1995 and May 1999, MOTT were cultured from sputum, bronchoalveolar lavage or resected lung specimens in 110 cases. 17 patients with MOTT pulmonary disease underwent pulmonary resection. Preoperatively, 5 of 17 patients had been diagnosed with MOTT pulmonary disease. The diagnosis of others was based on positive cultures from surgically resected material, and organism identification was successfully performed by the microplate DNA-DNA hybridization procedure. Surgical resections performed included wedge resection in 7, lobectomy in 6, and segmentectomy in 4. Antibiotics were generally continued for 6 to 24 months postoperatively. However, postoperative antibiotics therapy was not performed for patients who were postoperatively diagnosed with foci localized at the peripheral lung. Resected specimens yielded positive cultures for MOTT in all patients. There were no patients infected with M. kansasii. Regarding postoperative complications, 1 late bronchopleural fistula developed after right upper and middle lobectomy, and was treated with omentopexy. Persistent air leaks (> 7days) occurred in 5 patients, none of which occurred where linear stapling devices fitted with expanded polytetrafluoroethylene (ePTFE) sleeves were used. One patient diagnosed with M. szulgai postoperatively experienced reactivation 2 years after middle lobectomy despite postoperative antibiotic therapy for 6 months. Other patients have remained free of disease postoperatively. Surgical resection achieve good results for MOTT pulmonary disease, , and wedge resection or segmentectomy without postoperative antibiotic therapy was enough for patients whose foci localized at the peripheral lung and whose sputum or BAL cultures revealed no MOTT. Surgical treatment should be performed as early as possible before the pulmonary disease necessitates an extensive operation, and ePTFE sleeves were effective in preventing a postoperative prolonged air leak.

Key words:

Mycobacterium other than Mycobacterium tuberculosis (MOTT) - Surgery - Lung cancer

References

• 1 Snider D E Jr, Hopewell P C, Mills J, Reichman L B. Mycobacterioses and the acquired immunodeficiency syndrome.  Am Rev Respir Dis. 1987;  136 492-496
• 2 Prince D S, Peterson D D, Steiner R M. et al . Infection with Mycobacterium avium complex in patients without predisposing conditions.  N Engl J Med. 1989;  321 863-868
• 3 Kennedy T P, Weber D J. Nontuberculous mycobacteria. An underappreciated cause of geriatric lung disease.  Am J Respir Crit Care Med. 1994;  149 1654-1658
• 4 Aoki Y, Yamada H. Clinical application of microplate DNA-DNA hybridization procedure for rapid diagnosis of mycobacterial infections.  Tubercle and Lung Disease. 1994;  75 213-219
• 5 Pomerantz M, Madsen L, Gobe M, Isemaan M. Surgical management of resitant mycobacterial tuberculosis and other mycobacterial pulmonary infections.  Ann Thorac Surge. 1991;  52 1108-1112
• 6 Wallace R R Jr, O'Brien R, Glassroth J, Raleigh J, Dutt A. Diagnosis and treatment of disease caused by nontuberculous mycobacteria.  Am Rev Respir Dis. 1990;  142 940-953
• 7 Moran J F, Alexander L G, Staub E W, Young W G Jr, Sealy W C. Long-term results of pulmonary resection for atypical mycobacterium disease.  Ann Thorac Surg. 1983;  35 597-604
• 8 Shiraishi Y, Fukushima K, Komatsu H, Kurashima A. Early pulmonary resection for localized mycobacterium avium complex disease.  Ann Thorac Surg. 1998;  66 183-186