Table 1.
Clinical details of patients whose homes were sampleda
| Patient ID (gender; age [yr])b | Other patient/sampling environment characteristic(s) | Radiology | Microbiology and symptoms | Clinical notes |
|---|---|---|---|---|
| P1 (F; 72) | Gardener with ++ pots | BE | S++ bronchial wash in 2007, M. abscessus; cough, sputum, hemoptysis | Treated for 6 wk, clinically stable but remained culture positive, died from cancer of the pancreas in 2011 |
| P2 (F; 69) | Avid gardener | BE | Multiple S+ samples from 2004, progressive radiology, wt loss, hemoptysis; M. intracellulare in Sept and Dec 2004 (multiple), April 2006, June 2007, and June 2008 | Treated for 4 yr (ethambutol, rifampin, clarithromycin, clofazimine, and amikacin), converted sputum in July 2009; culture negative from 2010 to June 2011 |
| BE, small cavities | New infiltrate, increased cough and hemoptysis; 2 positive sputa in June 2011 (1/3); in Sept 2011 (1/3), M. kansasii | Treated for 12 mo with ethambutol, rifampin, and clarithromycin, converted sputum, in remission in 2013 | ||
| P3 (M; 72) | BE, nodules, large cavities | Multiple S+++ M. intracellulare, sputa from April 2006, significant wt loss, cough | Partial clinical response to treatment, but remains S++ C+, end-stage disease | |
| P4 (F; 74) | >400 orchids, exposure to ++ peat moss | Nodules, BE, small cavity | S++ M. intracellulare bronchial wash in Feb 2009; Pseudomonas aeruginosa, Aspergillus fumigatus, Trichosporin sp.; cough, sputum, hemoptysis | Treated with ethambutol, rifampin, and clarithromycin, converted sputum in Aug 2009; ongoing hemoptysis; ceased treatment at end of 2011 |
| Relapse/reinfection in 2013, new infiltrate; 1/3 sputa S− C+/−; bronchial wash S− C+ in Jan 2013, M. intracellulare | Commenced retreatment in Feb 2013 | |||
| P5 (F; 51) | Rainwater tanks | BE | Multiple sputa positive in 2007 for M. avium; previous S. aureus, new radiology, symptoms | Treated for 18 mo, converted sputum, still in remission |
| P6 (F; 72) | Large fernery, rainwater tanks | BE | Cough, sputum, respiratory failure, cachexia, progressive radiology; M. avium in 2007; M. intracellulare in 2006 and 2008 | Died from disease despite treatment in 2011 |
| P7 (F; 85) | Rainwater tanks | Nodules, BE | Cough, sputum, wt loss, sweats; bronchial wash in April 2008, Mycobacterium species; OLB in Nov 2008, M. lentiflavum | Treated for 2 yr with ethambutol, rifampin, and clarithromycin, remains in remission; P. aeruginosa |
| P8 (F; 63) | Rainwater tanks | BE | Recurrent LRTIs, persistent cough; bronchial wash in Nov 2007; in July 2008 and May 2010, M. intracellulare | Treated for 2 yr with ethambutol, rifampin, and clarithromycin, in remission |
| P9 (F; 63) | Gardener | BE, nodules | Hemoptysis; bronchial wash in Jan 2006, in Aug 2007, M. intracellulare | Treated for 18 mo, RML lobectomy in 2011; relapse/reinfection in 2013 |
| P10 (M; 81) | BE, nodules | Cough, sputum, SOB; bronchial wash in Oct 2007, M. intracellulare; sputum, M. abscessus, in Jan 2008, Apr 2008, and Sept 2008 and in 2012 | Treated for 6 wk with i.v. amikacin, cefoxitin, and clarithromycin in 2010 and for 2 wk in 2012 | |
| P11 (F; 75) | Didn't use shower, gardener, very dusty house | BE | Recurrent infections in RML, S. aureus; M. intracellulare isolated most frequently; M. intracellulare in March 2006; slow grower in April 2008; M. abscessus in June 2008; M. intracellulare in July 2008; M. peregrinum in July 2008; M. gordonae in Aug 2008; M. intracellulare in Sept to Dec 2008 (multiple); M. peregrinum in Dec 2008; M. intracellulare in Feb 2009 (multiple); M. peregrinum in March 2009; M. fortuitum in March 2009; M. fortuitum in May 2009; M. intracellulare in Oct 2009; M. fortuitum complex in Dec 2009; M. intracellulare in Jan 2010 | Treated for 24 mo with ethambutol, rifampin, clarithromycin, and ciprofloxacin, showed some symptomatic improvement, but didn't convert sputum; currently stable off treatment with chronic cough, sputum, and lethargy but reluctant for retreatment |
| P12 (M; 69) | Cactus house (>300 plants) | BE, nodules, cavities | M. intracellulare in 2003–2004; M. triplex in 2006; M. avium and M. intracellulare in 2007; M. intracellulare in 2008; Nocardia farcinica in 2009; M. intracellulare in 2009 | Treated over 3–4 yr, drug intolerances, peripheral neuropathy; eventually converted sputum; remains in remission |
| P13 (F; 60) | BE, nodules | M. intracellulare repeatedly from 2000–2007; M. avium after 15-mo remission in March 2005; RGM single isolates while on treatment for SGM; M. chelonae in May 2005; M. abscessus in Jan 2007 | RML lobectomy following 4 yr of treatment, drug side effects, and short relapse time; now deceased secondary to NTM disease | |
| P14 (M; 85) | Cavities | M. intracellulare in Dec 2006, March 2007, and April 2007 | Treated for 18 mo with ethambutol, rifampin, and clarithromycin, converted sputum | |
| P15 (M; 25) | BE, nodules, bronchiolitis | Post-pertussis bronchiolitis with secondary infection, M. abscessus subsp. bolletii in July-Sept 2011 | Treated for 6 mo with amikacin, cefoxitin, clarithromycin, and clofazimine | |
| P16 (F; 60) | RML BE | M. avium bronchial wash in 2007 | Treated for 6 mo, intolerant of medication; stable and culture negative off treatment | |
| P17 (F; 77) | BE | M. intracellulare in 2000; M. abscessus (multiple), including Sept 2008, Oct 2009, and Feb 2011 | M. intracellulare treated in 2000; in 2007, multiple courses of treatment for M. abscessus with partial response, limited by drug toxicity; respiratory failure secondary to disease, death | |
| P18 (F; 53) | Large cavities, nodules, BE | M. abscessus sputum in Oct 2010, bronchial wash in Dec 2010 (with S. aureus) and Dec 2012 and multiple in between | Heavy smoker of cigarettes, marijuana, large cavities; treated with i.v. therapy, response when abstinent from cigarettes; died from cancer of the lung and progressive cavitary disease | |
| P19 (F; 80) | BE | M. abscessus in March and April 2011 | Treated for 2 wk with amikacin and cefoxitin and 6 wk with clarithromycin and clofazimine; in remission | |
| P20 (F; 65) | Nodular BE | M. intracellulare in 2007, bronchial wash, granulomata on TBB | Progressive radiology and symptoms; treated with ethambutol, rifabutin, and clarithromycin in 2010; rash and hepatitis; treated with azithromycin, ethambutol, clofazimine, and amikacin, in remission |
a
Abbreviations: F, female; M, male; BE, bronchiectasis; S, smear; C, culture; LRTIs, lower respiratory tract infections; SOB, shortness of breath; RGM, rapidly growing mycobacteria; SGM, slowly growing mycobacteria; OLB, open lung biopsy; TBB, transbronchial lung biopsy. For smear and culture results, + and − indicate positive and negative to the general degree shown (where + is positive and +++ is highly positive).
b
Age calculated from date of first isolate.