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We report a rare case of a 70-year-old male with recurrent pneumothoraces within one year treated with intermittent insertion of chest tube on each occasion. Diagnostic testing was notable for a cystic lesion in the left lung that was initially interpreted as bulla on chest x-ray and chest computed tomographic scan. Due to thickening and nodularity changes of the thin wall of the cystic lesion, the patient underwent left upper lobectomy. Pathology showed poorly differentiated squamous cell carcinoma of the cystic lesion wall. This case emphasizes the importance of monitoring pulmonary cystic lesions especially in patients with a history of smoking and emphysema.

Stomatococcus mucilaginosus is an oral commensal that has been occasionally reported to cause severe infections in immunocompromised patients. There is no information about the pathogenic role of S. mucilaginosus in airway infections. In a cohort of 182 subjects with bronchiectasis, we found that 9% were colonized with S. mucilaginosus in their lower airways by culture growth from bronchoalveolar lavage. To address the pathogenic potential of S.mucilaginosus, we developed a murine model of S. mucilaginosus lung infection. Intratracheal injection of S. mucilaginosus in C57BL/6 mice resulted in a neutrophilic influx with production of proinflammatory cytokines, chemokines, and lipid mediators, mainly PGE2 with induction of cyclooxygenase-2 (COX-2) in the lungs. Presence of TLR2 was necessary for induction of COX-2 and production of PGE2 by S. mucilaginosus. TLR2-deficient mice showed an enhanced clearance of S. mucilaginosus compared with wild-type mice. Administration of PGE2 to TLR2−/− mice resulted in impaired clearance of S. mucilaginosus, suggesting a key role for COX-2–induced PGE2 production in immune response to S. mucilaginosus. Mechanistically, induction of COX-2 in macrophages was dependent on the p38-ERK/MAPK signaling pathway. Furthermore, mice treated with S. mucilaginosus and Pseudomonas aeruginosa showed an increased mortality compared with mice treated with PA103 or S. mucilaginosus alone. Inhibition of COX-2 significantly improved survival in mice infected with PA103 and S. mucilaginosus. These data provide novel insights into the bacteriology and personalized microbiome in patients with bronchiectasis and suggest a pathogenic role for S. mucilaginosus in patients with bronchiectasis.

Background Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms. Data about NTM in patients with non-CF bronchiectasis are limited. Methods In a retrospective study, data was collected on patients with bronchiectasis and patients who were diagnosed with NTM were identified. All patients diagnosed with bronchiectasis (code 494) using the International Classification of Diseases, ninth revision (ICD-9), between 1999 and 2006, were identified. Clinical data including radiology findings, lung function, progression of disease, and the presence of NTM in sputum were collected for those who met the study criteria. Results 300 patients with ICD code for bronchiectasis were found in the data. Of these, 182 patients were enrolled in the study after confirmation of the radiology findings of bronchiectasis by CT scanning. Patients were divided into two groups: bronchiectasis with NTM isolates ( n = 68) and bronchiectasis without NTM isolates ( n = 114). The clinical data was reviewed to define the clinical characteristics of these patients; 12% of the patients were found to have NTM from their sputum or BAL. Of the total patients, 55 (30%) of these met the American Thoracic Society criteria for the diagnosis of NTM disease. Mycobacterium avium complex (MAC) was the most common isolate. It was found that the probability of NTM isolation was significantly higher in elderly female patients ( p = 0.04) with a low body mass index (BMI) ( p = 0.002). Additionally, it was found that gram-negative rods were frequently isolated in these patients, and the frequency of exacerbations was significantly higher in patients with NTM infections. Conclusions NTM infections are common in non-CF bronchiectasis. MAC is the most frequently isolated NTM in these patients. Elderly female patients with a low BMI are a high-risk group for NTM infection in non-CF bronchiectasis. Furthermore, these patients are prone to secondary infections and frequent exacerbations. This study suggests a strong correlation between non-CF bronchiectasis and NTM. Thus, these patients should be routinely screened for NTM infections.

Summary Background Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms. Cystic fibrosis (CF) patients are susceptible to NTM, but data about NTM in patients with non-CF bronchiectasis are limited. Methods We conducted a retrospective, descriptive study at the University of Illinois Medical Center. All patients diagnosed with bronchiectasis (code 494) using the International Classification of Diseases, ninth revision (ICD-9), between 1999 and 2006, were identified. Clinical data including lung function, radiology studies, and presence of NTM in sputum were abstracted for those who met the study criteria. Results One hundred eighty-two patients were enrolled in the study. Patients were divided into two groups: bronchiectasis with NTM isolates ( n = 68) and bronchiectasis without isolates ( n =114), and compared for clinical characteristics and underlying diseases. Mycobacterium avium complex (MAC) was the most common isolate. Fifty-five patients (30%) met the American Thoracic Society criteria for diagnosis of NTM disease. Gram-negative rods were commonly co-isolated. The probability of NTM isolation was significantly higher in elderly female patients ( p = 0.04). Moreover, the probability of NTM isolation was significantly higher in the female group with low body mass index (BMI) ( p = 0.002). Conclusions NTM infections are common in non-CF bronchiectasis. MAC is the most frequently isolated NTM in these patients. There is also great variability in age and sex characteristics for NTM in non-CF bronchiectasis patients. Female patients with a low BMI are a high risk group for NTM infection in non-CF bronchiectasis. Routine screening for NTM is strongly recommended in this patient population.