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DOI: 10.1016/j.pulmoe.2020.09.001
Open Access
Available online 21 September 2020
Does alcohol consumption really affect the outcome of nontuberculous mycobacterial infections?
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H. Ito
Division of Hospital Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
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Table 1. The classic factors for developing and worsening NTM infections; NTM: nontuberculous mycobacterial; TNF-α: tumor necrosis factor alpha; INF-γ: interferon gamma.
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Dear Editor,

I read with great interest the article by Jacob et al., entitled “The effect of alcohol consumption in the treatment of nontuberculous mycobacteria.”1 Little is known about the relationship between alcohol consumption and nontuberculous mycobacterial (NTM) infections, and the result of this article will add insights into the exacerbating factors for this disease. However, it seems early to decide that alcohol consumption is a risk factor for worsening NTM infections.

This study did not refer to some important risk factors for developing NTM infections: the use of immunosuppressants, and the history of solid organ or hematopoietic stem cell transplantations (Table 1).2,3 Besides, it seems crucial to refer to the history of liver diseases. Although cirrhosis is not an established risk factor for developing NTM infections, the liver function is important in selecting the treatment regimen because of the hepatic toxicity of rifampicin and isoniazid.3

Table 1.

The classic factors for developing and worsening NTM infections; NTM: nontuberculous mycobacterial; TNF-α: tumor necrosis factor alpha; INF-γ: interferon gamma.

The risk factors for NTM infections 
Acquired immunodeficiency syndrome 
Cancer chemotherapy 
Carcinoma 
Chronic azithromycin use 
Immunosuppressants such as TNF-α inhibitors 
INF-γ receptor deficiencies, and auto-antibodies to INF-γ 
Inhaled antibiotics 
Oral and inhaled steroid therapy 
Peritoneal dialysis 
Proton pump inhibitors 
Signal transducer and activator of transcription 1 deficiency 
Transplant recipients 
Underlying lung diseases 

The factors I mentioned above were not included in the analysis in the article by Jacob et al. So, it seems premature to think that alcohol consumption is the risk factor for worsening NTM infections.

Authors contribution

Conceptualization, manuscript writing: Hiroshi Ito.

Final approval of manuscript: all authors.

Funding

None declared.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

The author is grateful to the members of the Division of Hospital Medicine, University of Tsukuba Hospital for the support of daily clinical practices.

References
[1]
M. Jacob, R. Silva, R. Gaio, R. Duarte.
The effect of alcohol consumption in the treatment of nontuberculous mycobacteria.
Pulmonology, 26 (2020), pp. 249-252
[2]
D.E. Griffith, T. Aksamit, B.A. Brown-Elliott, A. Catanzaro, C. Daley, F. Gordin, et al.
An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases.
Am J Respir Crit Care Med, 175 (2007), pp. 367-416
[3]
C.S. Haworth, J. Banks, T. Capstick, A.J. Fisher, T. Gorsuch, I.F. Laurenson, et al.
British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD).
Copyright © 2020. Sociedade Portuguesa de Pneumologia
Pulmonology

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