582. Laboratory Markers for Predicting Disease Activity in Patients with Disseminated Opportunistic Infections and Autoantibodies to Interferon- γ
Session: Poster Abstract Session: TB: Non-Tuberculous Mycobacterial Infections
Thursday, October 8, 2015
Room: Poster Hall
  • Poster_NTM_IDweek15.pdf (545.4 kB)
  • Background: A distinct clinical syndrome of disseminated nontuberculous mycobacteria (NTM) infections or other OI in previously healthy adult patients in association with anti-interferon- γ (IFN- γ) autoantibodies has recently been recognized, especially in Thailand. However, the natural history and factors predicting the disease activity remain unclear.

    Methods: All previously healthy and non-HIV infected adult patients, who was diagnosed with disseminated OI whom anti IFN-γ autoantibody was positive were recruited. The patients’ disease activity was defined into stable (resolution of fever, but incomplete resolution of other symptoms and signs, with concurrent use of oral antibiotic) and active disease (worsening of symptoms and signs which required intravenous antibiotic within the last 3 months) based on their clinical state at each clinic visit. White blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and anti IFN- γ autoantibody levels of patients during active and stable diseases were tested and compared. 

    Results: From 2007 to 2014, we identified 51 patients who developed this syndrome. Fifty-one cases had 115 episodes of opportunistic infections. Twenty-eight patients (54.9%) had NTM disease as their first presentation and Mycobacterium abscessus was the most common causative pathogen (60 of 115). Forty-five patients were followed up at Siriraj Hospital for a mean duration of 1 year (1-28 months) and a median of 3 visits (1-11).  Of 188 clinic visits, 64 and 124 visits were classified as active and stable disease, respectively. WBC count (14.11 vs. 8.02×109/l, p<0.001), ESR (86 vs. 36.5, p<0.001), CRP (28.24 vs. 4.66, p<0.001), and anti IFN- γ autoantibody levels (3.99 vs. 3.56, p<0.001) were significantly higher during active disease than stable disease. All factors except anti IFN- γ autoantibody levels remain significant associated with disease activity in the multivariate analysis: WBC (aOR 6.73; 95%CI 2.18-20.71), ESR (aOR 5.60; 95%CI 1.44-21.84), CRP (aOR 2.78; 95%CI 1.03-7.56).

    Conclusion: White blood cell count, CRP and ESR level can be used to predict disease activity in patients with disseminated OI in association with positive anti-interferon- γ autoantibodies. 

    Nasikarn Angkasekwinai, MD1, Pakpoom Phoompoung, MD2, Ekkarat Wongswat, MS2, Voravich Luangwedchakarn, MD3, Pinklow Umrod, MS3, Suporn Foongladda, DVM, PhD4, Manop Pithukpakorn, MD2 and Yupin Suputtamongkol, MD1, (1)Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, (2)Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand, (3)Faculty of Medicine Siriraj Hospital, Bangkok, Thailand, (4)Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand


    N. Angkasekwinai, None

    P. Phoompoung, None

    E. Wongswat, None

    V. Luangwedchakarn, None

    P. Umrod, None

    S. Foongladda, None

    M. Pithukpakorn, None

    Y. Suputtamongkol, None

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