Exacerbating Factors in Elderly Patients with Mycobacterium Avium Complex Pulmonary Disease

No previous studies have examined Mycobacterium avium complex pulmonary disease (MAC-PD) in only elderly patients 75 years old. Here, we investigated exacerbation factors of MAC-PD in elderly patients and clarified cases that can be followed up without MAC medication. METHODS: From April 2011 to March 2019, 126 advanced aged MAC-PD patients at our institute were newly diagnosed with pulmonary MAC disease, and were able to be observed based on radiological findings for over a year. Their medical records were retrospectively examined for clinical and radiological findings at the time of diagnosis and 1 year later. To identify the natural predictors of exacerbation, clinical characteristics of 109 treatment-nave patients were compared between exacerbated and unchanged groups. Additionally, the unchanged group was followed for one more year. RESULTS: In the present study, positive acid-fast bacilli smears from the sputum test, presence of cavitary lesions, and extensive radiological findings, particularly abnormal shadows in 3 lobes, were predictive of exacerbation among treatment-nave elderly MAC-PD patients. In the unchanged group, less than 10% showed exacerbation of radiological findings within the next year. CONCLUSION: If the sputum smear is negative, no cavitary lesions are present, and abnormal shadows are restricted to 2 lobes, elderly patients with MAC-PD may remain untreated for a few years.