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Introduction: Nontuberculous mycobacterial (NTM) pleuritis, pleural effusion combined with NTM lung disease (NTM-LD), has not been previously described as a common manifestation of NTM infections. Aims: This study aimed to investigate the clinical features and prognosis of NTM pleuritis. Methods: A retrospective observational study was performed including patients with NTM pleuritis fromJanuary 2001 to December 2017 at 8 hospitals. NTM pleuritis was defined as a positive culture of NTM from pleural effusion. Furthermore, we matched patients with NTM-LD but without pleuritis by sex and age (within a 10-year range) to obtain comparative data for individuals. We investigated the association between clinical parameters and prognosis. Results: We identified 58 patients with NTM pleuritis (median age, 72 years; 35 females; Mycobacterium avium complex [MAC], 48 patients). The median follow-up period was 16 months and 26 patients died. Patients with NTM pleuritis had significantly worse survival than sex- and age-matched patients presenting NTM-LD without pleuritis (P Conclusions: Our results suggest that prognosis of NTM pleuritis is worse than NTM-LD without pleuritis. Moreover, lower BMI, UPD, and no treatment history after pleuritis are associated with poor prognosis in patients with NTM pleuritis.

Background: Mycobacterium lentiflavum is one of the non-tuberculosis mycobacteria (NTM) which can cause cervical lymphadenitis and pulmonary infection, and the isolation frequency from laboratories over Japan in 2014 is estimated to be 1.1%, in the eighth place of NTMs (Takaki A. IJTLD 20 (11); 2016: S457). It will be useful to have the MIC profile of antibiotics against M. lentiflavum clinical isolates for the practical management of the patients. Methods: A total of 54 M . lentiflavum isolates were collected over Japan through 2002 to 2015, and identified by 16S rRNA, rpoB , hsp65 sequencing. MICs of 35 antibiotics for one type strain and those 54 isolates were determined according to CLSI M24-A2 (CAMHB+5%OADC at 30˚C). Results: The mode MICs of clofazimine (CFZ), trimethoprim/sulfamethoxazole (TMP/SMX) and clarithromycin (CLR) were low; ≤0.12 µg/ml, 0.5/9.5 µg/ml and 4 µg/ml, respectively, while two isolates showed high MIC for CLR, >32 µg/ml, and the other two also showed 4/76 µg/ml for MIC of TMP/SMX. The mode MICs of four quinolones [ofloxacin (OFX), levofloxacin (LFX), moxifloxacin (MFX), sitafloxacin (SFX)] and rifabutin (RFB) were relatively low; 8 µg/ml, 4 µg/ml, 2 µg/ml, 2 µg/ml and 1 µg/ml, respectively. One isolate showed high MIC for OFX (>64 µg/ml) and LFX (64 µg/ml). Ten anti-tuberculosis drugs, 10 s-lactams, 4 tetracyclines, 2 aminoglycosides and linezolid showed high MICs. Discussion and Conclusion: Our data suggested that CFZ, TMP/SMX and CLR could be effective against M. lentiflavum, though some guidelines indicate the use of rifamycin, ethambutol and CLR as standard combination.

Introduction: While multidrug regimen including inhaled amikacin (AMK) instead of intravenous administration has been recently used for the treatment of refractory non-tuberculous mycobacterial lung diseases (NTM-LD), available evidence is limited. Aims and objectives: We investigated the efficacy, safety and feasibility of inhaled AMK therapy administered to patients with refractory NTM-LD. Methods: The study population consisted of the 27 patients with NTM lung diseases due to Mycobacterium avium complex (MAC: N=24) and M. abscessus (Mab: N=3) who received the combination chemotherapy with inhalation of injectable AMK at Keio University Hospital (Tokyo, Japan) from January 2014 through May 2016. The efficacy, safety, and feasibility of the treatment were retrospectively evaluated. The Research Ethics Committee of Keio University Hospital reviewed and approved this study, and patient informed consent was obtained. Results: Twenty-three out of 27 cases (85.2%), comprising 21/24 MAC cases (87.5%) and 2/3 Mab cases (66.7%) were administered inhaled AMK for >3 months. Ten out of 23 cases (43.5%), comprising eight MAC cases (38.1%) and all two Mab cases (100%) showed sputum conversion defined as two consecutive culture negativity, with symptomatic improvement including cough and sputum. In addition, the serum AMK levels just before the second inhalation were Conclusions: Taken together inhaled AMK therapy is a safe and feasible therapy for refractory NTM-LD.