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(Chest. 2005;127:2287-2288.)
© 2005 American College of Chest Physicians

Postbronchoscopy Fever in Patients With Nontuberculous Mycobacterial Lung Disease

Won-Jung Koh, MD; Kyeongman Jeon, MD; Kyung Soo Lee, MD and O Jung Kwon, MD

Samsung Medical Center, Seoul, South Korea

Correspondence to: Won-Jung Koh, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, 50 Irwon-Dong, Gangnam-gu Seoul 135–710, South Korea; e-mail: wjkoh{at}smc.samsung.co.kr

To the Editor:

We read with great interest the report by Um et al (March 2004)1 on the incidence and risk factors of postbronchoscopy fever. They showed that fever developed in 7 of 48 patients (15%) with pulmonary tuberculosis, and pulmonary tuberculosis was the independent risk factor for postbronchoscopy fever. Interestingly, fever did not developed in 13 patients with positive nontuberculous mycobacteria (NTM) culture findings.1

The incidence of postbronchoscopy fever has not been well studied in patients with NTM lung disease. We recently performed a study2 to determine the frequency of NTM infection in 105 patients with bilateral bronchiectasis and bronchiolitis at chest CT. Bronchoscopy was performed in 43 patients (41%). NTM diseases were diagnosed in 25 of these 43 patients (58%) [Mycobacterium avium complex in 12 patients, Mycbacterium abscessus in 11 patients, and others in 2 patients].

Postbronchoscopy fever developed in 15 patients (43%). The incidence of fever was 48% (12 of 25 patients) in those with NTM disease. NTM disease was more common in the fever group (12 of 15 patients, 80%) than in the nonfever group (13 of 28 patients, 46%) [p = 0047]. Bacteremia was not found, and the fever subsided spontaneously within a day in all patients.

BAL was performed in 23 patients (92%), and transbronchial lung biopsies were performed in 20 patients (80%) with NTM disease. BAL or bronchial washing fluid smears were positive for acid-fast bacilli in 12 patients (48%) with NTM disease. The high incidence of postbronchoscopy fever in our patients with NTM disease was partially explained by these findings.

Elevated cytokines, such as tumor necrosis factor-{alpha} and interleukin-1ß, in BAL fluid might be responsible to postbronchoscopy fever in patients with pulmonary tuberculosis, as Um et al1 suggested. This may be also true in patients with NTM disease. Some reports34 revealed that many proinflammatory cytokines, such as tumor necrosis factor-{alpha}, interleukin-1ß, interleukin-6, and interleuklin-8, were increased in BAL fluid in patients with NTM disease. In summary, the high incidence of postbronchoscopy fever in patients with NTM lung disease may be related to the diagnostic techniques during bronchoscopic procedures, clinically advanced disease, or the release of pyrogenic cytokines, as well as pulmonary tuberculosis.

References

  1. Um, SW, Choi, CM, Lee, CT, et al (2004) Prospective analysis of clinical characteristics and risk factors of postbronchoscopy fever. Chest 125,945-952[Abstract/Free Full Text]
  2. Koh, WJ, Lee, KS, Kwon, OJ, et al Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in non-tuberculous mycobacterial pulmonary infection. Radiology 2005;235,282-288[Abstract/Free Full Text]
  3. Yamazaki, Y, Kubo, K, Sekiguchi, M, et al Analysis of BAL fluid in M. avium-intracellulare infection in individuals without predisposing lung disease. Eur Respir J 1998;11,1227-1231[Abstract]
  4. Yamazaki, Y, Kubo, K, Takamizawa, A, et al Markers indicating deterioration of pulmonary Mycobacterium avium-intracellulare infection. Am J Respir Crit Care Med 1999;160,1851-1855[Abstract/Free Full Text]




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