784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the U.S.
Session: Poster Abstract Session: Tuberculosis and Other Mycobacterial Infections
Thursday, October 4, 2018
Room: S Poster Hall

Background:

The epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the U.S. is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fold. Malignancy, immunosuppression and tumor necrosis factor inhibitors are known risk factors for DMAC. We sought to describe the epidemiology of DMAC disease in HIV seronegative patients in the US.

Methods:

We performed a retrospective analysis of a commercial database (Explorys Inc, Cleveland, OH). This database contains an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 1999 to present. Explorys contains de-identified information from over 50 million patients, 360 hospitals, and over 317,000 providers.

We identified a total of 571 persons diagnosed with DMAC, based on Systemized Nomenclature of Medicine-Clinical Terms. We excluded 80 HIV-infected and identified association of the infection with known risk factors.

Results:

Of 570 patients, 491 HIV-uninfected patients with DMAC were studied. Underlying structural pulmonary diseases were COPD and bronchiectasis (51 % and 47 %, respectively). 210 patients had concomitant malignancy of which lung cancer was the most frequent (43%). Seventy-nine per cent were receiving corticosteroids and 10 patients (2%) were on TNF inhibitors (2%).

Conclusion:

In this study, majority of patients with DMAC are HIV-uninfected. Larger studies should focus on identifying the prevalence and risk factors of DMAC in the post-AIDS era.

Table: Distribution of the sample according to associated conditions

N= 490 (%)

Age, years

Senior (> 65)

Adult (18 – 65)

330 (67%)

160 (33%)

Female

310 (63)

Smoking history

420 (86)

Bronchiectasis

230 (47)

Previous pulmonary tuberculosis

40 (8)

COPD

250 (51)

HTN

310 (63)

Diabetes mellitus

130 (27)

Chronic kidney disease

110 (22)

Interstitial lung disease

90 (18)

Inflammatory Bowel Disease

20 (4)

Concomitant malignancy

Lung

GI

Head and neck

Hematological

Renal

210 (43)

60 (28)

50 (23)

40 (19)

40 (19)

30 (14)

Chronic oral corticosteroid treatment

390 (79)

Tumor necrosis factor alpha inhibitor therapy

10 (2)

COPD; chronic obstructive pulmonary disease, HTN; hypertension, GI gastrointestinal

Khalid M. Dousa, MD, FACP, CABIM, Infectious Disease, University Hospitals, Case Western Reserve University, Cleveland, OH, Rafael Ponce-Terashima, MD, Case Wester Reserve University, Cleveland, OH, Daniel Van Aartsen, MD, University Hospitals, Case Western Reserve, Cleveland, OH, Alejandro De La Hoz, MD student, Grupo de Investigación en Enfermedades Infecciosas, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia and John L. Johnson, M.D., Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH

Disclosures:

K. M. Dousa, None

R. Ponce-Terashima, None

D. Van Aartsen, None

A. De La Hoz, None

J. L. Johnson, None

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