Epidemiology and Clinical Features of<i> Mycobacterium avium </i>Complex<i> </i>Pulmonary Disease in a Brazilian Amazon Cohort

Abstract

The incidence of <i>Mycobacterium avium</i> complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par&#225;, Brazil, from 2012 to 2020. The <i>M. avium</i> group represented 58.9% of cases, followed by <i>M. intr</i><i>a</i><i>cellulare</i> (35.7%), <i>M. colombiense</i> (3.6%), and <i>M. chimaera</i> (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.