Prospective outcomes of adults with speciated Mycobacterium avium complex lung disease, 2021-2026.

Authors

Scott K Heysell, Sharon Johnson, Lea Becker, Prakruti Rao, Caroline Nguyen, Julianna Lefcofrides, Catherine Strawley, Suzanne Stroup, Girija Ramakrishnan, William Kleinot, Michele Scheurenbrand, Laura Young, Jasie Hearn, Myra Williams, Joseph Falkinham, Sharvari Narendra, Salvador Castañeda-Barba, Michael Hanley, Alan Ropp, Amy Mathers, Eric R Houpt

Published in

Annals of the American Thoracic Society. Sep 03, 2026. Epub Sep 03, 2026.

Abstract

Mycobacterium avium complex lung disease (MAC-LD) is clinically heterogeneous and carries diverse outcomes.
To describe predictors of clinical progression of MAC-LD in a state-wide cohort.
We enrolled adults with MAC-LD from across Virginia, USA starting in 2021. Every 6 months we performed respiratory quality of life questionnaire, scored CT scans, and recorded respiratory mycobacterial cultures including MAC speciation. Outcomes were classified using NTM-NET consensus definitions, factors predicting clinical progression analyzed by Poisson regression, and hierarchical clustering on principal components derived from Factorial Analysis of Mixed Data.
Of 105 participants the median follow-up was 917 days. Mean age was 69.8 years, 79 (75%) were women, and 70 (67%) had nodular bronchiectasis. M. intracellulare was the most common species, present in 48 (46%) participants at enrollment, followed by M. avium (29, 28%), and M. intracellulare subspecies chimaera (11, 10%). Only 2 (9%) of 22 evaluable participants met the NTM-NET definition of cure. In all participants after multivariable adjustment, older baseline age (incidence rate ratio 1.03 [1, 1.06], p = 0.04) and fibrocavitary CT scan pattern (2.57 [1.33, 4.96], p = 0.005), were associated with unfavorable 12-month clinical progression. Species type and species persistence contributed to characteristics of three distinct phenotypes of MAC-LD of varying severity and clinical progression.
The majority of participants were not assessable for MAC-LD treatment outcomes using strict NTM-NET definitions. Species informed phenotypes of MAC lung disease are prognostically useful and can inform routine management and trial design.

PMID:
42690700
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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