Publication date: Available online 14 November 2017
Source:Revue des Maladies Respiratoires
Author(s): C. Balavoine, C. Andréjak, S. Marchand-Adam, F.X. Blanc
Les infections pulmonaires à mycobactéries non tuberculeuse (MNT) se rencontrent de plus en plus souvent dans la pratique du pneumologue. Le diagnostic repose sur une association de critères cliniques, microbiologiques et radiologiques. Plusieurs facteurs de risque d'infection à MNT ont déjà été décrits, comme les pathologies pulmonaires chroniques en général. Les patients atteints de bronchopneumopathie chronique obstructive (BPCO) ont un sur-risque de développer une infection à MNT (odds ratio [OR] à 15,7) dans une étude cas/témoin. Cette infection serait responsable d'un déclin plus rapide du volume expiratoire maximal en une seconde (VEMS) et augmenterait le nombre d'exacerbations par année. Les corticostéroïdes inhalés (CSI) chez les patients atteints de BPCO augmenteraient le risque de développer une infection à MNT (OR à 16,9), surtout si ces CSI sont toujours pris au moment du diagnostic. L'introduction d'un macrolide au long court à visée anti-inflammatoire chez les patients BPCO risquerait d'induire des résistances et donc de rendre nettement plus difficile le traitement d'une infection à MNT puisque celui-ci repose sur une association d'antibiotiques comportant un macrolide. L'infection à MNT chez les patients BPCO est sous-estimée et devrait être recherchée notamment lorsque les patients deviennent exacerbateurs fréquents ou chez ceux, dont la fonction respiratoire décline avant de mettre en place des CSI ou des macrolides.Nontuberculous mycobacteria (NTM) pulmonary infections are increasingly frequent in pneumological practice. The diagnosis is based on an association of clinical, microbiological and radiological criteria. Some risk factors for NTM disease have been described, including chronic respiratory diseases, but without specific focus on chronic obstructive pulmonary disease (COPD). COPD patients have more risk to be infected by NTM than patients with the main other chronic respiratory diseases (except cystic fibrosis) (odds ratio [OR] at 15.7 in a case-control study). This NTM pulmonary infection is associated with a greater decline in forced expiratory volume in one second (FEV1) and an increased exacerbation rate. Inhaled corticosteroids (ICS) increase the risk of COPD patients developing an NTM infection (OR at 16.9), especially if ICS are still used at the time of diagnosis. Chronic macrolide treatment could possibly select resistant NTM strains and so could make the treatment clearly more difficult as macrolides are the cornerstone NTM treatment. NTM infections in patients with COPD are probably underestimated and should be kept in mind, particularly when patients have frequent exacerbations and display accelerated respiratory function decline, before implementing ICS or macrolides.
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